Anemia as a risk factor for infectious diseases in infants and toddlers: Results from a prospective study

Abstract

Anemia due to iron deficiency is the most prevalent form of micronutrient malnutrition in the world, however, the causal relationship between anemia and infection remains unclear. We examined prospectively, the association between anemia and infection among Bedouin infants. We recruited 293 families and newborns from the Bedouin population, which is ongoing major lifestyle changes, during the periods of 1989-1992 and 1994-1997 and followed them to age 18 months. The number of diarrhea and respiratory disease episodes as well as total days of diarrhea were ascertained weekly. Hemoglobin levels were obtained at age 6 months. Additional data on feeding practices, environmental, household and demographic characteristics were obtained throughout the 18 months. Diarrhea before 6 months of age was found to be a risk factor for diarrhea after that age. After controlling for early morbidity < 6 months, anemia (Hb < 11 g/dl) at 6 months was an independent risk factor for diarrhea and respiratory illness from 7 to 18 months of age. This associations remained significant even after controlling, in addition, for environmental and socio-economic factors. In the multivariable models, anemia at age 6 months increased the risk for diarrhea after that age by 2.9-fold (95% confidence interval 1.6 - 5.3; p = 0.001) and that of respiratory disease by 2-fold (1.1 - 3.7; p = 0.03). Our findings suggest that anemia may increase the rates of infections in toddlers. The possibility that reducing anemia in infants may be a preventive measure to lower disease burden from infectious disease in this and other vulnerable populations should be tested in further studies.

Diagnosis of iron deficiency anemia in children of Northeast Brazil

“…Diarrhea during childhood, even of moderate severity, has been associated to lower iron absorption and consequent reduction in hemoglobin concentration. 11 With regard to parasitic diseases studies with infants conducted by Batista Filho & Ferreira 3 (1996) found no association with iron defi ciency anemia in the Northeastern region.…”

Anemia e deficiência de ferro em pré-escolares da Amazônia Ocidental brasileira: prevalência e fatores associados

“…Observação semelhante foi apontada para crianças de 6 a 59 meses do Timor Leste 32 , onde menores valores de hemoglobina sanguínea foram verificados em crianças com relato de diarréia nas últimas duas semanas prévias ao estudo. O aumento no risco de anemia com aumento de infecções diarréicas e respiratórias também foi verificado por Levy et al 33 , em estudo prospectivo com beduínos de 18 meses. De acordo com Beresford et al 34 , a diarréia pode ocasionar perda sanguínea intestinal e a ocorrência recente dessa infecção tem sido sugerida como um marcador de episódios mais freqüentes e persistentes.…”

Infectious Disease Morbidity Among Young HIV-1–Exposed But Uninfected Infants in Latin American and Caribbean Countries: The National Institute of Child Health and Human Development International Site Development Initiative Perinatal Study

“…37 Infant anemia has been associated with infectious gastrointestinal and respiratory morbidity in young infants from a developing country, even after controlling for environmental and socioeconomic factors. 38 The identification of anemia at birth as a risk factor for neonatal infections reinforces the need for close monitoring of hemoglobin values among infants of HIV-1-infected mothers, especially those whose mothers received antiretroviral drugs during pregnancy.…”