Correlates of Iron, Cobalamin, Folate, and Vitamin A Status among Stunted Children: A Cross-Sectional Study in Uganda

Abstract

Micronutrient deficiencies and stunting are prevalent. We assessed correlates of iron, cobalamin, folate, and vitamin A biomarkers in a cross-sectional study of stunted children aged 12–59 months in eastern Uganda. The biomarkers measured were serum ferritin (S-FE), soluble transferrin receptor (S-TfR), retinol binding protein (S-RBP), plasma cobalamin (P-Cob), methylmalonic acid (P-MMA), and folate (P-Fol). Using linear regression, we assessed socio-demography, stunting severity, malaria rapid test, and inflammation as correlates of micronutrient biomarkers. Of the 750 children, the mean (SD) age was 32.0 (11.7) months, and 45% were girls. Iron stores were depleted (inflammation-corrected S-FE < 12 µg/L) in 43%, and 62% had tissue iron deficiency (S-TfR > 8.3 mg/L). P-Cob was low (<148 pmol/L) and marginal (148–221 pmol/L) in 3% and 20%, and 16% had high P-MMA (>0.75 µmol/L). Inflammation-corrected S-RBP was low (<0.7 µmol/L) in 21% and P-Fol (<14 nmol/L) in 1%. Age 24–59 months was associated with higher S-FE and P-Fol and lower S-TfR. Breastfeeding beyond infancy was associated with lower iron status and cobalamin status, and malaria was associated with lower cobalamin status and tissue iron deficiency (higher S-TfR) despite iron sequestration in stores (higher S-FE). In conclusion, stunted children have iron, cobalamin, and vitamin A deficiencies. Interventions addressing stunting should target co-existing micronutrient deficiencies.

Correlates of early child development among children with stunting: A cross‐sectional study in Uganda

“…This has been demonstrated in studies (Caulfield et al, 1996 ; Grummer‐Strawn, 1993 ; Marquis et al, 1997 ) showing that still breastfed children were shorter and lighter than their nonbreastfed counterparts of the same age. This is in line with our findings including by (Mutumba et al, 2023 ), given that on top of poorer anthropometric indices, breastfed children had more anaemia and cobalamin deficient cases compared to the nonbreastfed, all suggesting that the poor development was not due to breastfeeding per se but rather the prolonged breastfeeding was being used as a countermeasure to other nutritional, clinical or physiological disruptions.…”

“…Venous blood was drawn from each child, transported to the field laboratory, processed, and temporarily stored at −20°C before being transported to Kampala for storage at −80°C. Processed samples were later transferred to Denmark and Germany on dry ice for analysis of the micronutrient biomarkers and acute phase proteins as elaborated elsewhere including justification for cut‐offs (Mutumba et al, 2023 ). Before processing, whole blood was used to diagnose malaria (rapid diagnostic test RDT, SD bioline malaria Ag Pf, Abbott) and measure haemoglobin concentration (Hb201+, HemoCue).…”

“…These included haemoglobin (Hb), anaemia (Hb < 110 g/L), ferritin, iron deficiency anaemia (IDA) (Hb < 110 g/L and serum ferritin < 12 µg/L), serum soluble transferrin receptors (>8.3 mg/L), inflammatory markers serum C‐reactive protein (CRP, >10 mg/L) and α−1‐acid glycoprotein (AGP, ≥1 g/L), plasma cobalamin (<148 pmol/l), plasma methylmalonic acid (MMA, >0.75 µmol/L) and malaria (positive RDT). The cutoffs used are as previously described (Mutumba et al, 2023 ) and serum ferritin was corrected for inflammation as described elsewhere (Cichon et al, 2018 ).…”

Micronutrient Status and Other Correlates of Hemoglobin among Children with Stunting: A Cross-Sectional Study in Uganda

“…We recently showed that a large proportion of children with stunting had deficiencies of iron, vitamin A or cobalamin [14]. Iron is a key component of hem in red blood cells and iron deficiency is a prominent cause of childhood anemia [15].…”