Anemia and iron deficiency in rural Bangladeshi pregnant women living in areas of high and low iron in groundwater

Ahmed, Faruk; Khan, Mohammad Rezwan; Shaheen, Najma; Ahmed, Kazi Matin; Hasan, A. K. M. Mahbub; Chowdhury, Ireen Akhtar; Chowdhury, Rafiqul I.

doi:10.1016/j.nut.2018.01.014

Cited by 29 publications

(34 citation statements)

References 22 publications

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“…Similarly, in Cambodia, elevated groundwater iron has also been reported and proposed as an explanation for the low iron deficiency prevalence in this region (37). We also found that heme-iron food consumption was associated with less anemia even when adjusting for groundwater iron, an association reported as nonsignificant or borderline in 2 other Bangladeshi populations (10, 38). This may be due to the higher groundwater iron content in the study site of Merrill et al.…”

Section: Discussionsupporting

confidence: 46%

“…(10) than in the FAARM trial area and to a much smaller sample size in that study ( n = 207), leading to wide CIs. Two additional studies with a larger sample size ( n = 522) in a setting with lower groundwater iron content also found no or borderline associations between red meat consumption and anemia (15, 38). However, both analyses further adjusted for iron status, which is on the causal pathway between dietary iron and anemia/Hb.…”

Section: Discussionmentioning

confidence: 93%

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Dietary Factors Moderate the Relation between Groundwater Iron and Anemia in Women and Children in Rural Bangladesh

Wendt

Waid

Gabrysch

2019

Current Developments in Nutrition

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Background Anemia affects ∼1.6 billion people worldwide, often owing to iron deficiency. In Bangladesh, high levels of anemia have been observed alongside little iron deficiency. Elevated concentrations of groundwater iron could constitute a significant source of dietary iron. Objective We aimed to quantify the effect of groundwater iron on anemia in nonpregnant women and young children in Bangladesh, taking into account dietary factors that may affect iron absorption. Methods We analyzed data on 1871 nonpregnant women and 987 children (6–37 mo) from the 2015 baseline survey of the Food and Agricultural Approaches to Reducing Malnutrition cluster-randomized trial in Sylhet, Bangladesh. We used logistic regression with robust standard errors to assess effects of self-reported groundwater iron, dietary intake, and sociodemographic characteristics on anemia, considering interactions between groundwater iron and dietary factors. Results Groundwater iron presence was associated with less anemia in women (OR: 0.74; 95% CI: 0.60, 0.90) and children (OR: 0.58; 95% CI: 0.44, 0.76). This effect was modified by dietary factors. In women, the effect of groundwater iron on anemia was stronger if no vitamin C–rich or heme-iron foods were consumed, and there was a clear dose–response relation. In children, intake of vitamin C–rich foods strengthened the effect of groundwater iron on anemia, and there was no evidence for interaction by intake of iron-rich foods. Conclusions Heme-iron and vitamin C consumption reduced the effect of groundwater iron on anemia among women but not children in Bangladesh, which may be due to higher levels of iron deficiency and lower levels of iron intake among children. Vitamin C consumption appears to enhance iron absorption from groundwater in children and they may thus benefit from consuming more vitamin C–rich fruits and vegetables. Even among women and children consuming heme-iron or vitamin C–rich foods and groundwater iron, anemia prevalence remained elevated, pointing to additional causes of anemia beyond iron deficiency. This trial was registered at clinicaltrials.gov as NCT02505711.

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Section: Discussionsupporting

confidence: 46%

Section: Discussionmentioning

confidence: 93%

Dietary Factors Moderate the Relation between Groundwater Iron and Anemia in Women and Children in Rural Bangladesh

Wendt

Waid

Gabrysch

2019

Current Developments in Nutrition

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“…Iron is one of the most abundant metals on Earth, and is ubiquitous in groundwater sources depending on the environment over which the water flows [17,18]. Recent studies have shown a significant association between iron status and daily iron intake from drinking groundwater in different population groups [15,19]. Further, iron status was observed to be good in Bangladeshi populations who are drinking from groundwater with a high level of iron [15,18,19,20].…”

Section: Introductionmentioning

confidence: 99%

“…Recent studies have shown a significant association between iron status and daily iron intake from drinking groundwater in different population groups [15,19]. Further, iron status was observed to be good in Bangladeshi populations who are drinking from groundwater with a high level of iron [15,18,19,20]. In the country, the MNP program for the prevention of childhood anemia suffers poor coverage (~2%–3%, personal communication), and the side-effects are documented [21].…”

Section: Introductionmentioning

confidence: 99%

Effect of Micronutrient Powder (MNP) with a Low-Dose of Iron on Hemoglobin and Iron Biomarkers, and Its Effect on Morbidities in Rural Bangladeshi Children Drinking Groundwater with a High-Level of Iron: A Randomized Controlled Trial

et al. 2019

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Micronutrient Powder (MNP) is beneficial to control anemia, but some iron-related side-effects are common. A high level of iron in the groundwater used for drinking may exacerbate the side-effects among MNP users. We conducted a randomized controlled trial examining the effect of a low-dose iron MNP compared with the standard MNP in children aged 2–5 years residing in a high-groundwater-iron area in rural Bangladesh. We randomized 327 children, who were drinking from the “high-iron” wells (≥2 mg/L), to receive either standard (12.5 mg iron) or low-dose iron (5.0 mg iron) MNP, one sachet per day for two months. Iron parameters were measured both at baseline and end-point. The children were monitored weekly for morbidities. A generalized linear model was used to determine the treatment effect of the low-dose iron MNP. Poisson regressions were used to determine the incidence rate ratios of the morbidities. The trial was registered at ISRCTN60058115. Changes in the prevalence of anemia (defined as a hemoglobin level < 11.0 g/dL) were 5.4% (baseline) to 1.0% (end-point) in the standard MNP; and 5.8% (baseline) to 2.5% (end-point) in the low-dose iron MNP groups. The low-dose iron MNP was non-inferior to the standard MNP on hemoglobin outcome (β = −0.14, 95% CI: −0.30, 0.013; p = 0.07). It resulted in a lower incidence of diarrhea (IRR = 0.29, p = 0.01, 95% CI: 0.11–0.77), nausea (IRR = 0.24, p = 0.002, 95% CI: 0.09–0.59) and fever (IRR = 0.26, p < 0.001, 95% CI: 0.15–0.43) compared to the standard MNP. Low-dose iron MNP was non-inferior to the standard MNP in preventing anemia yet demonstrated an added advantage of lowering the key side-effects.

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“…These results go in hand with Milman et al (29) who suggested that between 32-39 wk GA, prevalence of ID and IDA was 28-85% and 21-35%, respectively, among European women and Bah et al (30) who found the prevalence of anemia increased from 34.6% at 14 wk to 50% at 20 wk GA. Recently, Ahmed et al (31) reported an overall frequency of anemia, ID and IDA of 34.7%, 27% and 13.4% of their series of pregnant women.…”

Section: Results:-mentioning

confidence: 99%

Can Vitamin D Supplemental Therapy Improve Pregnancy-Associated Anemia? An Interventional Prospective Clinical Trial.

MD¹,

MD²

2018

IJAR

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Objectives: To evaluate impact of vitamin D supplemental therapy (VD-ST) and iron ST (IST) on hemoglobin concentration (HC) in pregnant women. Patients & Methods: 187 women pregnant were clinically evaluated and gave blood samples at 1 st trimester for estimation of HC and serum 25OH-VD, ferritin concentration (FC), hepcidin (HPC) and interleukin-6 (IL-6). Women were categorized according to the levels of estimated parameters into control and study groups AD. Women of groups A and C received VD-ST alone, group B received IST alone and group D received both ST. At delivery, HC, extent of change and frequency of pregnancy-associated anemia (PAA) were determined. Results: At 1 st trimester, 71.7% women were anemic and 38.5% had hypoferremia, 77% had VD deficiency (VDD) and 59.4% had both VDD and PAA. Serum HPC and IL-6 levels in anemic women especially those had VDD were significantly higher than control women. At delivery, 35% of control women developed PAA and mean HC was significantly lower than 1 st trimester HC with a median deficit of 4.72 gm/dl (IQR: 2.8-6.4) among studied population. Frequency of anemic women in groups B-D was decreased at delivery by 21.7%, 30.8% and 30.6%, respectively. Statistical analyses defined high serum HPC and IL-6 levels at 1 st trimester as specific early predictors for PAA development, but early institution of ST especially VD-ST is one of the best significant predictors for improved HC at time of delivery. Conclusion: VDD, hypoferremia, higher HPC and IL-6 levels constitute a vicious circle entrapping pregnant women and inducing iron deficiency anemia at delivery. Early institution of VD-ST and IST can burst this circle and induce improvement of HC up to normal range in about 30% of women presented by PAA. Thus, early estimation of HC and serum VD can be used as a guide for early institution of ST.

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Anemia and iron deficiency in rural Bangladeshi pregnant women living in areas of high and low iron in groundwater

Cited by 29 publications

References 22 publications

Dietary Factors Moderate the Relation between Groundwater Iron and Anemia in Women and Children in Rural Bangladesh

Dietary Factors Moderate the Relation between Groundwater Iron and Anemia in Women and Children in Rural Bangladesh

Effect of Micronutrient Powder (MNP) with a Low-Dose of Iron on Hemoglobin and Iron Biomarkers, and Its Effect on Morbidities in Rural Bangladeshi Children Drinking Groundwater with a High-Level of Iron: A Randomized Controlled Trial

Can Vitamin D Supplemental Therapy Improve Pregnancy-Associated Anemia? An Interventional Prospective Clinical Trial.

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