title: Micronutrient deficiencies are common in 6- to 8-year-old children of rural Nepal, with prevalence estimates modestly affected by inflammation.
abstract: Subclinical micronutrient deficiencies remain a hidden aspect of malnutrition for which comprehensive data are lacking in school-aged children. We assessed the micronutrient status of Nepalese children, aged 6 to 8 y, born to mothers who participated in a community-based antenatal micronutrient supplementation trial from 1999 to 2001. Of 3305 participants, plasma indicators were assessed in a random sample of 1000 children. Results revealed deficiencies of vitamins A (retinol <0.70 μmol/L, 8.5%), D (25-hydroxyvitamin D <50 nmol/L, 17.2%), E (α-tocopherol <9.3 μmol/L, 17.9%), K (decarboxy prothombin >2 μg/L, 20%), B-12 (cobalamin <150 pmol/L, 18.1%), B-6 [pyridoxal-5'-phosphate (PLP) <20 nmol/L, 43.1%], and β-carotene (41.5% <0.09 μmol/L), with little folate deficiency (6.2% <13.6 nmol/L). Deficiencies of iron [ferritin <15 μg/L, 10.7%; transferrin receptor (TfR) >8.3 mg/L, 40.1%; TfR:ferritin >500 μg/μg, 14.3%], iodine (thyroglobulin >40 μg/L, 11.4%), and selenium (plasma selenium <0.89 μmol/L, 59.0%) were observed, whereas copper deficiency was nearly absent (plasma copper <11.8 μmol/L, 0.7%). Hemoglobin was not assessed. Among all children, 91.7% experienced at least 1 micronutrient deficiency, and 64.7% experienced multiple deficiencies. Inflammation (α-1 acid glycoprotein >1 g/L, C-reactive protein >5 mg/L, or both) was present in 31.6% of children, affecting the prevalence of deficiency as assessed by retinol, β-carotene, PLP, ferritin, TfR, selenium, copper, or having any or multiple deficiencies. For any nutrient, population deficiency prevalence estimates were altered by ≤5.4% by the presence of inflammation, suggesting that the majority of deficiencies exist regardless of inflammation. Multiple micronutrient deficiencies coexist in school-aged children in rural Nepal, meriting more comprehensive strategies for their assessment and prevention.
authors.affiliation: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD kschulze@jhsph.edu.
authors.forename: Kerry J
authors.initials: KJ
authors.lastname: Schulze
authors.affiliation: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Parul
authors.initials: P
authors.lastname: Christian
authors.affiliation: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Lee S F
authors.initials: LS
authors.lastname: Wu
authors.affiliation: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Margia
authors.initials: M
authors.lastname: Arguello
authors.affiliation: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Hongjie
authors.initials: H
authors.lastname: Cui
authors.affiliation: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Ashika
authors.initials: A
authors.lastname: Nanayakkara-Bind
authors.affiliation: Program in International and Community Nutrition, University of California, Davis, CA; and.
authors.forename: Christine P
authors.initials: CP
authors.lastname: Stewart
authors.affiliation: The Nepal Nutrition Intervention Project-Sarlahi, Nepal Netra Jyoti Sangh, Tripureswor, Kathmandu, Nepal.
authors.forename: Subarna K
authors.initials: SK
authors.lastname: Khatry
authors.affiliation: The Nepal Nutrition Intervention Project-Sarlahi, Nepal Netra Jyoti Sangh, Tripureswor, Kathmandu, Nepal.
authors.forename: Steven
authors.initials: S
authors.lastname: LeClerq
authors.affiliation: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Keith P
authors.initials: KP
authors.lastname: West
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D003300:Copper / Q000008:administration & dosage / Q000097:blood / Q000172:deficiency; D003430:Cross-Sectional Studies; D019587:Dietary Supplements; D005260:Female; D005293:Ferritins / Q000097:blood; D005494:Folic Acid Deficiency / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage / Q000097:blood* / Q000172:deficiency*; D009390:Nepal / Q000453:epidemiology; D009752:Nutritional Status; D015995:Prevalence; D011990:Receptors, Transferrin / Q000097:blood / Q000172:deficiency; D012424:Rural Population; D012643:Selenium / Q000008:administration & dosage / Q000097:blood; D012959:Socioeconomic Factors; D014801:Vitamin A / Q000008:administration & dosage / Q000097:blood; D014807:Vitamin D / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000097:blood; D024502:alpha-Tocopherol / Q000008:administration & dosage / Q000097:blood
chemical_list: D006454:Hemoglobins; D018977:Micronutrients; D011990:Receptors, Transferrin; D014801:Vitamin A; D014807:Vitamin D; D003300:Copper; D002097:C-Reactive Protein; D005293:Ferritins; C104450:25-hydroxyvitamin D; D024502:alpha-Tocopherol; D012643:Selenium
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