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      Anemia and Micronutrient Status of Women of Childbearing Age and Children 6–59 Months in the Democratic Republic of the Congo

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          Abstract

          Little is known about the micronutrient status of women and children in the Democratic Republic of the Congo, which is critical for the design of effective nutrition interventions. We recruited 744 mother-child pairs from South Kivu (SK) and Kongo Central (KC). We determined hemoglobin (Hb), serum zinc, vitamin B12, folate, ferritin, soluble transferrin receptor (sTfR), retinol binding protein (RBP), C-reactive protein, and α-1 acid glycoprotein concentrations. Anemia prevalence was determined using Hb adjusted for altitude alone and Hb adjusted for both altitude and ethnicity. Anemia prevalence was lower after Hb adjustment for altitude and ethnicity, compared to only altitude, among women (6% vs. 17% in SK; 10% vs. 32% in KC), children 6–23 months (26% vs. 59% in SK; 25% vs. 42% in KC), and children 24–59 months (14% vs. 35% in SK; 23% vs. 44% in KC), respectively. Iron deficiency was seemingly higher with sTfR as compared to inflammation-adjusted ferritin among women (18% vs. 4% in SK; 21% vs. 5% in KC), children 6–23 months (51% vs. 14% in SK; 74% vs. 10% in KC), and children 24–59 months (23% vs. 4% in SK; 58% vs. 1% in KC). Regardless of indicator, iron deficiency anemia (IDA) never exceeded 3% in women. In children, IDA reached almost 20% when sTfR was used but was only 10% with ferritin. Folate, B12, and vitamin A (RBP) deficiencies were all very low (<5%); RBP was 10% in children. The prevalence of anemia was unexpectedly low. Inflammation-adjusted zinc deficiency was high among women (52% in SK; 58% in KC), children 6–23 months (23% in SK; 20% in KC), and children 24–59 months (25% in SK; 27% in KC). The rate of biochemical zinc deficiency among Congolese women and children requires attention.

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          Anemia and iron deficiency: effects on pregnancy outcome.

          This article reviews current knowledge of the effects of maternal anemia and iron deficiency on pregnancy outcome. A considerable amount of information remains to be learned about the benefits of maternal iron supplementation on the health and iron status of the mother and her child during pregnancy and postpartum. Current knowledge indicates that iron deficiency anemia in pregnancy is a risk factor for preterm delivery and subsequent low birth weight, and possibly for inferior neonatal health. Data are inadequate to determine the extent to which maternal anemia might contribute to maternal mortality. Even for women who enter pregnancy with reasonable iron stores, iron supplements improve iron status during pregnancy and for a considerable length of time postpartum, thus providing some protection against iron deficiency in the subsequent pregnancy. Mounting evidence indicates that maternal iron deficiency in pregnancy reduces fetal iron stores, perhaps well into the first year of life. This deserves further exploration because of the tendency of infants to develop iron deficiency anemia and because of the documented adverse consequences of this condition on infant development. The weight of evidence supports the advisability of routine iron supplementation during pregnancy.
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            Principles of nutritional assesMSent

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              Adjusting plasma ferritin concentrations to remove the effects of subclinical inflammation in the assessment of iron deficiency: a meta-analysis.

              The World Health Organization recommends serum ferritin concentrations as the best indicator of iron deficiency (ID). Unfortunately, ferritin increases with infections; hence, the prevalence of ID is underestimated. The objective was to estimate the increase in ferritin in 32 studies of apparently healthy persons by using 2 acute-phase proteins (APPs), C-reactive protein (CRP) and alpha(1)-acid glycoprotein (AGP), individually and in combination, and to calculate factors to remove the influence of inflammation from ferritin concentrations. We estimated the increase in ferritin associated with inflammation (ie, CRP gt 5 mg/L and/or AGP gt 1 g/L). The 32 studies comprised infants (5 studies), children (7 studies), men (4 studies), and women (16 studies) (n = 8796 subjects). In 2-group analyses (either CRP or AGP), we compared the ratios of log ferritin with or without inflammation in 30 studies. In addition, in 22 studies, the data allowed a comparison of ratios of log ferritin between 4 subgroups: reference (no elevated APP), incubation (elevated CRP only), early convalescence (both APP and CRP elevated), and late convalescence (elevated AGP only). In the 2-group analysis, inflammation increased ferritin by 49.6% (CRP) or 38.2% (AGP; both P lt 0.001). Elevated AGP was more common than CRP in young persons than in adults. In the 4-group analysis, ferritin was 30%, 90%, and 36% (all P lt 0.001) higher in the incubation, early convalescence, and late convalescence subgroups, respectively, with corresponding correction factors of 0.77, 0.53, and 0.75. Overall, inflammation increased ferritin by ap 30% and was associated with a 14% (CI: 7%, 21%) underestimation of ID. Measures of both APP and CRP are needed to estimate the full effect of inflammation and can be used to correct ferritin concentrations. Few differences were observed between age and sex subgroups.
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                Author and article information

                Journal
                Nutrients
                Nutrients
                nutrients
                Nutrients
                MDPI
                2072-6643
                17 February 2016
                February 2016
                : 8
                : 2
                : 98
                Affiliations
                [1 ]Food, Nutrition and Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada; sarah.harvey@ 123456ubc.ca (S.H.-L.); crystal.karakochuk@ 123456alumni.ubc.ca (C.D.K.); meaghanhawes@ 123456hotmail.com (M.H.); kristina.michaux@ 123456ubc.ca (K.D.M.); kyly@ 123456mail.ubc.ca (K.C.W.); jenniferkfoley@ 123456gmail.com (J.F.); judy.mclean@ 123456ubc.ca (J.M.)
                [2 ]Faculty of Medicine, University of Goma, Goma, Democratic Republic of the Congo; pltugirimana@ 123456gmail.com
                [3 ]Department of Clinical Biology, College of Medicine and Heath Science, University of Rwanda, Kigali, Rwanda
                [4 ]Faculty of Medicine, Catholic University of Bukavu, Bukavu, Democratic Republic of Congo; esto.bahizire@ 123456gmail.com
                [5 ]Center of Research in Natural Sciences of Lwiro, Bukavu, Democratic Republic of the Congo
                [6 ]Department of Nutrition, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo; pierretulanefp@ 123456gmail.com
                [7 ]Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC V6T 1Z4, Canada; larry.lynd@ 123456ubc.ca
                [8 ]International Food Policy Research Institute, Washington, DC 20006, USA; m.moursi@ 123456cgiar.org (M.M.); e.boy@ 123456cgiar.org (Er.B.)
                [9 ]Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand; lisa.houghton@ 123456otago.ac.nz (L.A.H.); gibson@ 123456otago.ac.nz (R.S.G.)
                [10 ]South Australian Health and Medical Research Institute, and the Women’s and Children’s Health Research Institute, Adelaide 5000, Australia
                Author notes
                [* ]Correspondence: tim.green@ 123456sahmri.com ; Tel.: +61-88128-4000
                [†]

                These authors contributed equally to the data analysis and preparation of the manuscript.

                Article
                nutrients-08-00098
                10.3390/nu8020098
                4772060
                26901219
                362a71c7-f44d-4258-a218-8b58c1f992d2
                © 2016 by the authors; licensee MDPI, Basel, Switzerland.

                This article is an open access article distributed under the terms and conditions of the Creative Commons by Attribution (CC-BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 07 January 2016
                : 05 February 2016
                Categories
                Article

                Nutrition & Dietetics
                anemia,deficiency,democratic republic of the congo,ferritin,hemoglobin,inflammation,iron deficiency,micronutrient

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