Objectives: Despite repeated governmental and nongovernmental interventions, anemia remains a widespread public health concern in Peru. This article examines nutritional and disease factors associated with the prevalence of anemia and response to iron supplementation in Peruvian children, with the aim of understanding the lack of success of national programs.Methods: Data come from children, aged 2-5 years (n = 102), living in periurban Lima. Predictors of anemia and response to iron supplementation were explored at the individual, maternal, household, and environmental levels using logistic regression models, adjusted for clustering by household.Results: Half of the children in this sample were anemic and 50% of the anemic children responded to iron supplementation. We identified several factors that were associated with child anemia status and response to iron supplementation. Lower weight-for-age z-scores and the winter season were strong predictors of child anemia status and nonresponse to iron supplementation.Living with paternal grandparents was protective against anemia and elevated C-reactive protein at the time of the final interview was associated with a lack of response to iron supplementation. Conclusions:The findings of this study document an association between children's anemia status and their nutritional and ecological environment, highlighting the importance of examining anemia within a specific context to better understand the factors driving this important health problem.

In this study, morbidity status was not predictive of iron deficient status over a six-month interval period, but nonreplete iron status was shown to be associated with current morbidity symptoms. These results support investigating iron status as an allostatic system that responds to infection adaptively, rather than expecting an optimal preinfection value.

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Objectives Peruvians are experiencing rapid dietary and lifestyle changes, resulting in a phenomenon known as the “dual burden of disease.” A common manifestation of the dual burden in individuals is the co‐occurrence of overweight and anemia. Despite recent initiatives introduced to address these concerns, rates continue to be public health concerns. This study investigates the relationship between immune activation and lack of response to iron supplementation after 1 month of treatment and explores variation in body fat stores as a potential moderator between immune function and response to treatment. Methods Data come from children, aged 2–5 years (n = 50) from a peri‐urban community in Lima, Peru. Multivariate logistic regression models were used to explore the associations between response to treatment (Hb > =11.0 g/dl) after 1 month of treatment), markers of immune activation (C‐reactive protein [CRP] and reported morbidity symptoms), and measures of body fat (waist‐to‐height ratio, triceps skinfold thickness, and body mass index [BMI]). Results We found that high CRP is associated with a lack of response to iron supplementation after 1 month of treatment and that BMI z‐score may moderate this association. Generally, larger body size is associated with response to iron supplementation whether or not the children in this sample have high immune activation. However, the probability of anemic children responding to iron supplementation treatment differed across adiposity measures. Conclusions Our finding suggesting that adiposity and CRP influence response to iron supplementation, furthers our understanding of the relationship between inflammation and anemia treatment in children and has both theoretical and public health implications.