title: Only a small proportion of anemia in northeast Thai schoolchildren is associated with iron deficiency.
abstract: BACKGROUND
  Iron deficiency is assumed to be the major cause of anemia in northeast Thailand, but other factors may be involved.
  
  
  OBJECTIVE
  We determined the prevalence of anemia among schoolchildren in northeast Thailand and the role of hemoglobinopathies, selected micronutrient deficiencies, and other factors in hemoglobin status.
  
  
  METHODS
  Blood samples were collected from 567 children aged 6-12.9 y attending 10 primary schools for the determination of a complete blood count and hemoglobin type [Hb AA (normal hemoglobin), Hb AE (heterozygous for Hb type E), and Hb EE (homozygous for Hb type E)] and the measurement of serum ferritin, transferrin receptor, retinol, vitamin B-12, and plasma and erythrocyte folate concentrations. Children with a C-reactive protein concentration > or = 10 mg/L (n = 12), which indicated infection, were excluded.
  
  
  RESULTS
  The prevalence of anemia was 31%. Age, hemoglobin type, and serum retinol were the major predictors of hemoglobin concentration. Hb AA and Hb AE children with anemia had lower (P < 0.01) hematocrit, mean cell volume, and serum retinol values than did their nonanemic counterparts; no significant differences in serum ferritin were found by hemoglobin type. Only 16% (n = 22) of the anemic Hb AA and Hb AE children were iron deficient. Hb AA and Hb AE children with a serum retinol concentration <0.70 micromol/L (n = 14) had a significantly higher geometric mean serum ferritin concentration than did those with a retinol concentration > or = 0.70 micromol/L (P = 0.009); no significant difference in transferrin receptor concentrations was found between these 2 groups.
  
  
  CONCLUSIONS
  Hemoglobinopathies, suboptimal vitamin A status, and age were the major predictors of hemoglobin concentration. The contribution of iron deficiency to anemia was low, and its detection was complicated by coexisting suboptimal vitamin A status.
authors.affiliation: Institute of Nutrition, Mahidol University, Salaya, Thailand.
authors.forename: Rosanne A
authors.initials: RA
authors.lastname: Thurlow
authors.forename: Pattanee
authors.initials: P
authors.lastname: Winichagoon
authors.forename: Timothy
authors.initials: T
authors.lastname: Green
authors.forename: Emorn
authors.initials: E
authors.lastname: Wasantwisut
authors.forename: Tippawan
authors.initials: T
authors.lastname: Pongcharoen
authors.forename: Karl B
authors.initials: KB
authors.lastname: Bailey
authors.forename: Rosalind S
authors.initials: RS
authors.lastname: Gibson
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000453:epidemiology*; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D005492:Folic Acid / Q000097:blood; D006304:Health Status; D006446:Hemoglobin E / Q000032:analysis; D006801:Humans; D000090463:Iron Deficiencies; D008297:Male; D013785:Thailand / Q000453:epidemiology; D014801:Vitamin A / Q000097:blood; D014805:Vitamin B 12 / Q000097:blood
chemical_list: D014801:Vitamin A; D006446:Hemoglobin E; D005492:Folic Acid; D014805:Vitamin B 12