title: Distribution of anemia associated with micronutrient deficiencies other than iron in a probabilistic sample of Mexican children.
abstract: BACKGROUND
  This investigation aims to explore the association among anemia and vitamins A, C, and folate deficiencies in a probabilistic sample of Mexican children.
  
  
  METHODS
  Data on hemoglobin, serum vitamins A and C and folate concentrations and percent transferrin saturation (PTS) in children 0.5-11 years (n = 1,770) were extracted from the database of the probabilistic Mexican National Nutrition Survey 1999 (NNS-99).
  
  
  RESULTS
  Overall, 16.6% of children were anemic. Iron deficiency children with or without anemia had more frequent low serum retinol (40.6 vs. 16% and 27.7 vs. 11.9%, p < 0.05, respectively) and lower hemoglobin folate (11.5 vs. 22%, p < 0.05) than their non-iron deficiency counterparts. Mean concentrations of serum iron (p < 0.01), folate (p < 0.001) and retinol (p < 0.0001), but not ascorbic acid (p < 0.6), were significantly lower in anemic than in nonanemic children. In a linear regression model, 15% of hemoglobin variation in children was explained by retinol, folate and PTS, but not vitamin C (p <0.0001).
  
  
  CONCLUSIONS
  Anemia was mostly associated with iron deficiency and with a lesser proportion of folate and vitamin A deficiencies. Vitamin A deficiency might be overestimated since iron deficiency may lower serum retinol concentrations. Interventions aimed to reduce anemia in this population must consider interactions between those micronutrients in designing strategies.
authors.affiliation: Center for Research on Nutrition and Health, Instituto Nacional de Salud Pública, Cuernavaca, Mexico. svillalp@insp.mx
authors.forename: Salvador
authors.initials: S
authors.lastname: Villalpando
authors.forename: Ana Beatriz
authors.initials: AB
authors.lastname: Pérez-Expósito
authors.forename: Teresa
authors.initials: T
authors.lastname: Shamah-Levy
authors.forename: Juan A
authors.initials: JA
authors.lastname: Rivera
mesh_terms: D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000453:epidemiology* / Q000209:etiology; D001205:Ascorbic Acid / Q000097:blood; D001206:Ascorbic Acid Deficiency / Q000097:blood / Q000453:epidemiology; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D005492:Folic Acid / Q000097:blood; D005494:Folic Acid Deficiency / Q000097:blood / Q000453:epidemiology; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007223:Infant; D007501:Iron / Q000097:blood; D000090463:Iron Deficiencies; D008297:Male; D008800:Mexico / Q000453:epidemiology; D018977:Micronutrients / Q000172:deficiency*; D008875:Middle Aged; D015995:Prevalence; D012494:Sampling Studies; D014168:Transferrin / Q000032:analysis; D014801:Vitamin A / Q000097:blood; D014802:Vitamin A Deficiency / Q000097:blood / Q000453:epidemiology
chemical_list: D006454:Hemoglobins; D018977:Micronutrients; D014168:Transferrin; D014801:Vitamin A; D002097:C-Reactive Protein; D005492:Folic Acid; D007501:Iron; D001205:Ascorbic Acid