The Influence of Malnutrition and Micronutrient Status on Anemic Risk in Children under 3 Years Old in Poor Areas in China.
BACKGROUND
Malnutrition and anemia affect large numbers of young children living in poor areas of China. Multi-micronutrient deficiencies may be related to the prevalence of anemia in different populations, and identifying the risk factors that render children susceptible to anemia is the first step in combating anemia effectively.


METHODS
In this cross-sectional study, a total of 1370 children under 3 years old were selected based on probability proportional to size sampling principles from poor counties of China. Basic characteristics data were collected by questionnaire; then anthropometrics and hemoglobin were measured in the field and anemia prevalence evaluated. Venous blood was drawn from children aged 12-35 months (N = 553) to evaluate micronutrient status. Logistic regression was used to identify the risk factors for children's anemia.


RESULTS
Among children aged 0-35 months, the prevalence of stunting, low body weight and wasting was 17.5%, 8.6% and 5.1%, respectively, and 25.6% of the children were affected by anemia, with more anemic infants and younger children than older children (P <0.01). There were 26.5%, 12.8%, 14.1% and 20.0% of the children aged 12-35 months affected by iron deficiency, vitamin D deficiency, folic acid deficiency and vitamin B12 deficiency, respectively. For children aged 0-11 months who were breastfed, the mothers' anemic status was the only factor associated with the child's anemia (OR = 2.6; 95% CI: 1.2-5.4, P < 0.05). For children aged 12-35 months, multivariate logistic regression indicated that anemia was significantly associated with iron and vitamin B12 deficiency (OR = 5.3; 95% CI: 1.9-14.5, P < 0.01) and monotonous diet (OR = 2.3; 95% CI: 1.1-4.7, P < 0.05) after adjusting for age and gender.


CONCLUSIONS
The prevalence of anemia was higher in children under 2 years old and requires urgent intervention. An effective intervention strategy should include iron and vitamin B12 supplements, improving dietary diversity and controlling breastfeeding mothers' anemia.
Department of Maternal and Child Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China.
Jie
J
Wang
Department of Population Research, China Population and Development Research Center, Beijing, China.
Hui
H
Wang
Section of Health and Nutrition and Water, Environment and Sanitation, United Nations Children's Fund, Beijing, China.
Suying
S
Chang
Department of Nutrition Surveillance, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China.
Liyun
L
Zhao
Department of Nutrition on Aging, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China.
Ping
P
Fu
Department of Nutrition Surveillance, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China.
Wentao
W
Yu
Department of Nutrition on Aging, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China.
Qingqing
Q
Man
Section of Health and Nutrition and Water, Environment and Sanitation, United Nations Children's Fund, Beijing, China.
Robert
R
Scherpbier
Department of Maternal and Child Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China.
Lili
L
Pan
Department of Maternal and Child Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China.
Yifan
Y
Duan
Department of Maternal and Child Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China.
Shi-An
SA
Yin
D018798:Anemia, Iron-Deficiency / Q000453:epidemiology*; D001827:Body Height / Q000502:physiology; D001835:Body Weight / Q000502:physiology; D015362:Child Nutrition Disorders / Q000453:epidemiology / Q000503:physiopathology*; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004032:Diet; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D044342:Malnutrition / Q000453:epidemiology / Q000503:physiopathology*; D011204:Poverty Areas; D012306:Risk; D011795:Surveys and Questionnaires; D014131:Trace Elements / Q000097:blood*; D014815:Vitamins / Q000097:blood*
D014131:Trace Elements; D014815:Vitamins