title: Relationship of vitamin A deficiency, iron deficiency, and inflammation to anemia among preschool children in the Republic of the Marshall Islands.
abstract: BACKGROUND
  Although vitamin A deficiency, iron deficiency, and inflammation may contribute to anemia, their relative contribution to anemia has not been well characterized in preschool children in developing countries.
  
  
  OBJECTIVE
  To characterize the contributions of vitamin A and iron deficiencies and inflammation to anemia among preschool children in the Republic of the Marshall Islands.
  
  
  METHODS
  A community-based survey, the Republic of the Marshall Islands Vitamin A Deficiency Study, was conducted among 919 preschool children. The relationship of vitamin A and iron status and markers of inflammation, tumor necrosis factor-alpha, alpha1-acid glycoprotein, and interleukin-10, to anemia were studied in a subsample of 367 children.
  
  
  RESULTS
  Among the 367 children, the prevalence of anemia was 42.5%. The prevalence of severe vitamin A deficiency (serum vitamin A < 0.35 micromol/l) and iron deficiency (serum ferritin < 12 microg/dl) were 10.9 and 51.7%, respectively. The respective prevalence of iron deficiency anemia (hemoglobin < 110 g/l and iron deficiency), anemia with inflammation (anemia with TNF-alpha > 2 pg/ml and/or AGP > 1000 mg/l), and severe vitamin A deficiency combined with anemia was 26.7, 35.6, and 7.6%. In multivariate linear regression models that adjusted for age, sex, and inflammation, both iron deficiency (odds ratio (OR) 1.74, 95% confidence interval (CI) 1.08-2.83, P = 0.023) and severe vitamin A deficiency (OR 4.85, 95% CI 2.14-10.9, P < 0.0001) were significantly associated with anemia.
  
  
  CONCLUSIONS
  Both iron and vitamin A deficiencies were independent risk factors for anemia, but inflammation was not a significant risk factor for anemia among these preschool children.
authors.affiliation: Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
authors.forename: M V
authors.initials: MV
authors.lastname: Gamble
authors.forename: N A
authors.initials: NA
authors.lastname: Palafox
authors.forename: B
authors.initials: B
authors.lastname: Dancheck
authors.forename: M O
authors.initials: MO
authors.lastname: Ricks
authors.forename: K
authors.initials: K
authors.lastname: Briand
authors.forename: R D
authors.initials: RD
authors.lastname: Semba
mesh_terms: D000740:Anemia / Q000453:epidemiology / Q000209:etiology*; D018798:Anemia, Iron-Deficiency / Q000453:epidemiology / Q000209:etiology; D002675:Child, Preschool; D016001:Confidence Intervals; D005260:Female; D005293:Ferritins / Q000097:blood; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007249:Inflammation / Q000150:complications* / Q000453:epidemiology; D000090463:Iron Deficiencies; D016014:Linear Models; D008297:Male; D008849:Micronesia; D015999:Multivariate Analysis; D009752:Nutritional Status; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D014802:Vitamin A Deficiency / Q000150:complications* / Q000453:epidemiology
chemical_list: D006454:Hemoglobins; D005293:Ferritins