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Hemoglobinopathies and Child Feeding Practices as Predictors of Anemia in Rural Laotian Children: Evidence from the Lao Zinc Study
Author(s) -
Barffour Maxwell Adusei,
Hinnouho GuyMarino,
Wessells Kimberly Ryan,
Brown Keneth H,
Chanhthavong Bigphone,
Ratsavong Kethmany,
Sanchaisuriya Kanokwan,
Kounnavong Sengchanh,
Fucharoen Supan,
Hess Sonja Y
Publication year - 2017
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.31.1_supplement.299.4
Subject(s) - breastfeeding , medicine , anemia , hemoglobin , hemoglobinopathy , pediatrics , meal , demography , environmental health , hemolytic anemia , sociology
Understanding the genetic and nutritional determinants of anemia is critical in designing interventions. We compared differences in anemia by hemoglobinopathy status and child feeding practices, using baseline data of 6–23 month old children (n=900) from rural Khammouane district, Lao PDR, who are participating in the Lao Zinc Study. First, we explored the associations between anemia and two structural hemoglobin variants, namely a) Hemoglobin (Hb) E‐trait (defined as normal (HbAA), homozygote‐HbEE or heterozygote (HbEA)), and b) Hemoglobin F (defined as hereditary persistence of fetal hemoglobin (HPFH) if relative abundance ≥5%, or normal if otherwise). Next, on the basis of the results of the anemia‐hemoglobinopathy analyses, we evaluated the associations between anemia and child feeding practices, stratified by HbE‐trait. We defined breastfeeding (BF) as at least one‐time breastfeeding in the past month. Using World Health Organization (WHO) guidelines, adequate meal frequency (AMF) was defined as a minimum meal frequency of 2 (6–8 month) or 3 (9–23 month) if BF or 4 if non‐BF. Adequate dietary diversity (ADD) was defined as consumption of at least 4 of 7 food groups as specified by the WHO, in the past 24 hours. Consumption of animal source food (ASF) was defined as intake of at least 1 of 4 animal source foods in the past 24 hours. Anemia was defined as Hb <110 g/l. The distribution of children by HbE was 31% (HbAA), 57% (HbEA) and 12% (HbEE). Prevalence of HPFH was 15%. The prevalence of breastfeeding was 67%, AMF was 12%, consumption of ASF was 72% and ADD was 24%. Overall anemia prevalence was 51%, although prevalence differed by HbE status (40% for HbAA, 53% for HbEA and 70% for HbEE; p<0.001) and by HbF status (67% for HPFH and 48% if otherwise; p<0.001). In a multivariate logistic regression model including HbE, HbF and age, the odds of anemia was increased in children with HbEA (OR=1.7, P=0.001) and HbEE (OR=3.4; P<0.001) relative to the HbAA children. HbF was not associated with increased anemia risk after adjusting for HbE and age. In the HbE‐stratified analyses, we found no evidence of an association between anemia and either AMF or ASF, irrespective of HbE or BF status. However, in HbAA children, ADD was associated with a lower anemia prevalence in BF children (OR=0.44, P=0.037), but not non‐BF children (OR=1.64, P=0.303). Our data suggests that in this population, hemoglobinopathies, breastfeeding and complementary feeding practices are important predictors of anemia. Support or Funding Information Funding for this research was provided by the Mathile Institute for the Advancement of Human Nutrition, the Micronutrient Initiative and the Bill & Melinda Gates Foundation.