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Iron deficiency is uncommon among lactating women in urban Nepal, despite a high risk of inadequate dietary iron intake

  • Sigrun Henjum (a1), Mari Manger (a2), Eli Skeie (a2), Manjeswori Ulak (a3), Andrew L. Thorne-Lyman (a4) (a5), Ram Chandyo (a2) (a3), Prakash S. Shrestha (a3), Lindsey Locks (a4), Rune J. Ulvik (a6) (a7), Wafaie W. Fawzi (a4) (a8) (a9) and Tor A. Strand (a2) (a10)...
Abstract

The main objective of the present study was to examine the association between dietary Fe intake and dietary predictors of Fe status and Hb concentration among lactating women in Bhaktapur, Nepal. We included 500 randomly selected lactating women in a cross-sectional survey. Dietary information was obtained through three interactive 24 h recall interviews including personal recipes. Concentrations of Hb and plasma ferritin and soluble transferrin receptors were measured. The daily median Fe intake from food was 17·5 mg, and 70 % of the women were found to be at the risk of inadequate dietary Fe intake. Approximately 90 % of the women had taken Fe supplements in pregnancy. The prevalence of anaemia was 20 % (Hb levels < 123 g/l) and that of Fe deficiency was 5 % (plasma ferritin levels < 15 μg/l). In multiple regression analyses, there was a weak positive association between dietary Fe intake and body Fe (β 0·03, 95 % CI 0·014, 0·045). Among the women with children aged < 6 months, but not those with older infants, intake of Fe supplements in pregnancy for at least 6 months was positively associated with body Fe (P for interaction < 0·01). Due to a relatively high dietary intake of non-haem Fe combined with low bioavailability, a high proportion of the women in the present study were at the risk of inadequate intake of Fe. The low prevalence of anaemia and Fe deficiency may be explained by the majority of the women consuming Fe supplements in pregnancy.

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Corresponding author
* Corresponding author: S. Henjum, email sigrun.henjum@hioa.no
References
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1 World Health Organization, United Nations Children's Fund, United Nations University (2001) Iron Deficiency Anaemia Assessment, Prevention, and Control. A Guide For Programme Managers. Geneva: WHO. http://www.who.int/nutrition/publications/micronutrients/anaemia_iron_deficiency/WHO_NHD_01.3/en/index.html.
2 McLean E, Cogswell M, Egli I, et al. (2009) Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993–2005. Public Health Nutr 12, 444454.
3 Zimmermann MB & Hurrell RF (2007) Nutritional iron deficiency. Lancet 370, 511520.
4 Chandyo RK, Strand TA, Ulvik RJ, et al. (2007) Prevalence of iron deficiency and anemia among healthy women of reproductive age in Bhaktapur, Nepal. Eur J Clin Nutr 61, 262269.
5 NDHS: Ministry of Health and Population (Nepal) (2012) Nepal Demographic Health Survey – 2011. Kathmandu, Nepal: New ERA and ICF International.
6 Makhoul Z, Taren D, Duncan B, et al. (2012) Risk factors associated with anemia, iron deficiency and iron deficiency anemia in rural Nepali pregnant women. Southeast Asian J Trop Med Public Health 43, 735746.
7 Backstrand JR, Allen LH, Black AK, et al. (2002) Diet and iron status of nonpregnant women in rural Central Mexico. Am J Clin Nutr 76, 156164.
8 Torheim LE, Ferguson EL, Penrose K, et al. (2010) Women in resource-poor settings are at risk of inadequate intakes of multiple micronutrients. J Nutr 140, 2051S2058S.
9 Gibson RS & Ferguson EL (2008) An Interactive 24-Hour Recall for Assessing the Adequacy of Iron and Zinc Intakes in Developing Countries. HarvestPlus Technical Monograph 8. Washington, DC: International Food Policy Research Institute (IFPRI) and International Center for Tropical Agriculture (CIAT).
10 Food and Agriculture Organization of the United Nations (2010) Food Composition: Overview of the WorldFood Dietary Assessment System. http://typo3.fao.org/fileadmin/templates/food_composition/documents/World_food_dietary_assessment_system/Overview_of_the_WorldFood_Dietary_Assessment_System.pdf.
11 Gopalan C, Rama Sastri B & Balasubramanian S (1989) Nutritive Value of Indian Foods. Hyderabad, India: National Institute of Nutrition.
12 Institute of Nutrition Mahidol University (2002) Food Composition Database for INMUCAL Program. Thailand: Institute of Nutrition.
13 United States Department of Agriculture, Agricultural Research Service (2012) Search the USDA National Nutrient Database for Standard Reference. http://ndb.nal.usda.gov/.
14 Haubrock J, Nothlings U, Volatier JL, et al. (2011) Estimating usual food intake distributions by using the multiple source method in the EPIC-Potsdam Calibration Study. J Nutr 141, 914920.
15 Harttig U, Haubrock J, Knuppel S, et al. (2011) The MSM program: web-based statistics package for estimating usual dietary intake using the Multiple Source Method. Eur J Clin Nutr 65, Suppl. 1, S87S91.
16 Murphy SP, Beaton GH & Calloway DH (1992) Estimated mineral intakes of toddlers: predicted prevalence of inadequacy in village populations in Egypt, Kenya, and Mexico. Am J Clin Nutr 56, 565572.
17 Bhargava A, Bouis HE & Scrimshaw NS (2001) Dietary intakes and socioeconomic factors are associated with the hemoglobin concentration of Bangladeshi women. J Nutr 131, 758764.
18 World Health Organization, Food and Agriculture Organization of the United Nations (2002) Human Vitamin and Mineral Requirements. Rome, Italy: Food and Agriculture Organization of the United Nations (FAO).
19 World Health Organization, Food and Agriculture Organization of the United Nations (2006) Guidelines for Food Fortification with Micronutrients [Allen LH, de Benois B, Dary O and Hurrell R, editors]. Geneva: World Health Organization, Food and Agriculture Organization of the United Nations.
20 WHO (2006) Global Database on Body Mass Index: An Interactive Surveillance Tool for Monitoring Nutrition Transition. Geneva: WHO.
21 Hemocue Corporate (2011) Our Products – Hemoglobin Portfolio. Available at http://www.hemocue.com/index.php?page = 51.
22 Goodman RA (1989) Current trends: CDC criteria for anemia in children and child bearing-aged women. MMWR Morb Mortality Wkly Rep 38, 400404.
23 Kolbe-Busch S, Lotz J, Hafner G, et al. (2002) Multicenter evaluation of a fully mechanized soluble transferrin receptor assay on the Hitachi and Cobas Integra analysers. The determination of reference ranges. Clin Chem Lab Med 40, 529536.
24 Cook JD, Flowers CH & Skikne BS (2003) The quantitative assessment of body iron. Blood 101, 33593364.
25 Flowers CH, Skikne BS, Covell AM, et al. (1989) The clinical measurement of serum transferrin receptor. J Lab Clin Med 114, 368377.
26 Pfeiffer CM, Cook JD, Mei Z, et al. (2007) Evaluation of an automated soluble transferrin receptor (sTfR) assay on the Roche Hitachi analyzer and its comparison to two ELISA assays. Clin Chim Acta 382, 112116.
27 Hosmer DW & Lemeshow S (2000) Applied Logistic Regression, 2nd ed. New York: John Wiley & Sons.
28 Wood SN (2000) Modelling and smoothing parameter estimation with multiple quadratic penalties. J R Statist Soc B 62, 413428.
29 Hallberg L, Bengtsson C, Lapidus L, et al. (1993) Screening for iron deficiency: an analysis based on bone-marrow examinations and serum ferritin determinations in a population sample of women. Br J Haematol 85, 787798.
30 Bothwell TH, Charlton RW, Cook JD, et al. (1979) Iron Metabolism in Man. Oxford, UK: Blackwell Scientific Publications.
31 Moser PB, Reynolds RD, Acharya S, et al. (1988) Copper, iron, zinc, and selenium dietary intake and status of Nepalese lactating women and their breast-fed infants. Am J Clin Nutr 47, 729734.
32 WHO (2004) Assessing the Iron Status of Populations: A Report of a Joint World Health Organization/Centers for Disease Control Technical Consultation on the Assessment of Iron Status at the Population Level. Geneva: WHO.
33 Suma RC, Sheetal G, Jyothi LA, et al. (2007) Influence of phytin phosphorous and dietary fibre on in vitro iron and calcium bioavailability from rice flakes. Int J Food Sci Nutr 58, 637643.
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British Journal of Nutrition
  • ISSN: 0007-1145
  • EISSN: 1475-2662
  • URL: /core/journals/british-journal-of-nutrition
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