title: Disadvantaged pre-schoolers attending day care in Salvador, Northeast Brazil have a low prevalence of anaemia and micronutrient deficiencies.
abstract: OBJECTIVE
  To examine the micronutrient status of disadvantaged pre-schoolers from Northeast Brazil, following the introduction of pro-poor policies, by assessing the prevalence of anaemia and micronutrient deficiencies and the role of sociodemographic factors, genetic Hb disorders and parasitic infections.
  
  
  METHODS
  In a cross-sectional study, data on sociodemographic status, health, growth, genetic Hb disorders, parasites and nutrient supply from day-care meals were obtained. Fasting blood samples were collected and analysed for Hb, serum ferritin, transferrin receptor, folate, vitamin B₁₂, retinol, Zn and Se.
  
  
  METHODS
  Seven philanthropic day-care centres serving urban slums in Salvador, Northeast Brazil.
  
  
  METHODS
  Pre-schoolers aged 3-6 years from disadvantaged households.
  
  
  RESULTS
  Of the 376 sampled children, 94 % were of black or mixed race; 33 % and 29 % had at least one genetic Hb disorder and intestinal parasite, respectively. Stunting and underweight were ≤5 %; 14 % were overweight. Day-care centres supplied micronutrient-dense meals and snacks each weekday. Less than 10 % of pre-schoolers had anaemia and micronutrient deficiencies. Predictors (P < 0·05) of Hb were α(3·7) thalassaemia, Se and retinol (but not ferritin). Micronutrient predictors (P < 0·05) were: elevated α₁-glycoprotein for ferritin, Hb AS and BMI Z-score >1 for transferrin receptor, Zn and elevated α₁-glycoprotein for retinol, sex and helminths for Se, helminths for vitamin B₁₂, and Giardia intestinalis infection for serum folate.
  
  
  CONCLUSIONS
  Impaired growth, anaemia and micronutrient deficiencies were uncommon among these disadvantaged pre-schoolers attending day care. A range of interventions including provision of micronutrient-dense, fortified day-care meals, deworming and vitamin A supplementation likely contributed to improved micronutrient status, suggesting expanded coverage of these programmes.
authors.affiliation: 1Department of Human Nutrition,University of Otago,PO Box 56,Dunedin,New Zealand.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Lander
authors.affiliation: 1Department of Human Nutrition,University of Otago,PO Box 56,Dunedin,New Zealand.
authors.forename: Karl B
authors.initials: KB
authors.lastname: Bailey
authors.affiliation: 1Department of Human Nutrition,University of Otago,PO Box 56,Dunedin,New Zealand.
authors.forename: Alastair G
authors.initials: AG
authors.lastname: Lander
authors.affiliation: 2Department of Pathology,University of Otago,Dunedin,New Zealand.
authors.forename: Abdulmonem A
authors.initials: AA
authors.lastname: Alsaleh
authors.affiliation: 3Hospital Universitário Professor Edgard Santos,Fima Lifshitz Research Unit,Salvador,Bahia,Brazil.
authors.forename: Hugo C
authors.initials: HC
authors.lastname: Costa-Ribeiro
authors.affiliation: 3Hospital Universitário Professor Edgard Santos,Fima Lifshitz Research Unit,Salvador,Bahia,Brazil.
authors.forename: Angela P
authors.initials: AP
authors.lastname: Mattos
authors.affiliation: 3Hospital Universitário Professor Edgard Santos,Fima Lifshitz Research Unit,Salvador,Bahia,Brazil.
authors.forename: Danile L
authors.initials: DL
authors.lastname: Barreto
authors.affiliation: 1Department of Human Nutrition,University of Otago,PO Box 56,Dunedin,New Zealand.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Houghton
authors.affiliation: 2Department of Pathology,University of Otago,Dunedin,New Zealand.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Morison
authors.affiliation: 4Department of Preventive and Social Medicine,University of Otago,Dunedin,New Zealand.
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Williams
authors.affiliation: 1Department of Human Nutrition,University of Otago,PO Box 56,Dunedin,New Zealand.
authors.forename: Rosalind S
authors.initials: RS
authors.lastname: Gibson
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000191:economics / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002656:Child Day Care Centers; D002657:Child Development; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003677:Deficiency Diseases / Q000191:economics / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D004032:Diet / Q000009:adverse effects / Q000191:economics; D005260:Female; D063105:Food Assistance; D005522:Food Services / Q000191:economics; D005527:Food, Fortified / Q000191:economics; D006801:Humans; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage / Q000172:deficiency / Q000191:economics / Q000627:therapeutic use*; D009752:Nutritional Status; D011203:Poverty; D015995:Prevalence; D012959:Socioeconomic Factors; D014504:Urban Health / Q000191:economics
chemical_list: D018977:Micronutrients