title: Anemia and malnutrition in indigenous children and adolescents of the Peruvian Amazon in a context of lead exposure: a cross-sectional study.
abstract: BACKGROUND
  Indigenous children and adolescents of the Peruvian Amazon live in precarious conditions that could increase the risk of malnutrition. A particular problem in the Corrientes river communities is the high exposure to lead among children and adolescents.
  
  
  OBJECTIVE
  This study aimed to determine the nutritional status of children and adolescents in indigenous communities in the Corrientes river basin and examine risk factors for anemia, stunting, underweight, and wasting.
  
  
  METHODS
  This was a cross-sectional assessment in children and adolescents aged 0-17 years from six communities (n=330). Data collection included measurement of hemoglobin levels, anthropometrics, blood lead levels (BLLs); a parental questionnaire including demographic and dwelling information; parents' occupation; and the child's duration of breastfeeding and food consumption. Analysis included univariate, bivariate, and logistic regression.
  
  
  RESULTS
  Overall, anemia prevalence was 51.0%, stunting (proxy for chronic malnutrition) 50.0%, and underweight 20.0%. Bivariate analysis showed that anemia and underweight prevalence was higher in the 0-4 years group (p<0.05). No association was found between anemia, stunting, or underweight with gender, community exposure to oil activity, or consumption of river water. Stunting prevalence was higher in the group whose BLLs were >5 µg/dL (p<0.05). In the logistic regression analysis, no variable was associated with anemia or underweight. The group 5-11 years and >12 years had 1.9 and 3.1 times higher risk of stunting than the group under five years, respectively. Children and adolescents with BLLs >5 µg/dL had twice the risk of stunting compared to those with lower BLLs.
  
  
  CONCLUSIONS
  Half of the study population was found with anemia and stunting. Anemia was more prevalent in the 0- to 5-year age group and stunting in the 12- to 17-year group. The association between stunting and BLLs might be attributed to a direct effect of lead on human growth. Also, poor nutrition and other socioeconomic-related factors may contribute to the simultaneous existence of stunting and elevated BLLs.
authors.affiliation: Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Fundación Cayetano Heredia, Casa Honorio Delgado, Lima, Perú; cynthiaanticona@hotmail.com.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Anticona
authors.affiliation: Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: Miguel
authors.initials: M
authors.lastname: San Sebastian
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000740:Anemia / Q000453:epidemiology*; D001827:Body Height; D001835:Body Weight; D002648:Child; D015362:Child Nutrition Disorders / Q000453:epidemiology*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007199:Indians, South American / Q000706:statistics & numerical data*; D007223:Infant; D007231:Infant, Newborn; D007854:Lead / Q000097:blood; D007855:Lead Poisoning / Q000453:epidemiology*; D008297:Male; D010568:Peru / Q000453:epidemiology; D012307:Risk Factors
chemical_list: D006454:Hemoglobins; D007854:Lead
keywords: Peruvian Amazon; anemia; indigenous; lead exposure; malnutrition