Zinc, Gravida, Infection, and Iron, but Not Vitamin B-12 or Folate Status, Predict Hemoglobin during Pregnancy in Southern Ethiopia

Abstract

The etiology of anemia during pregnancy in rural Southern Ethiopia is uncertain. Intakes of animal-source foods are low and infections and bacterial overgrowth probably coexist. We therefore measured the dietary intakes of a convenience sample of Sidama women in late pregnancy who consumed either maize (n = 68) or fermented enset (Enset ventricosum) (n = 31) as their major energy source. Blood samples were analyzed for a complete blood count, vitamin B-12 and folate status, plasma ferritin, retinol, zinc, albumin, and C-reactive protein (CRP). The role of infection and gravida was also examined. Dietary intakes were calculated from 1-d weighed records. No cellular animal products were consumed. Of the women, 29% had anemia, 13% had iron deficiency anemia, 33% had depleted iron stores, and 74 and 27% had low plasma zinc and retinol, respectively. Only 2% had low plasma folate (< 6.8 nmol/L) and 23% had low plasma vitamin B-12 (< 150 pmol/L), even though 62% had elevated plasma methylmalonic acid (MMA) (> 271 nmol/L). None had elevated plasma cystathionine or total homocysteine (tHcys). Women with enset-based diets had higher (P = 0.052) plasma vitamin B-12 concentration and lower (P < 0.05) cell volume, plasma cystathionine, and retinol than women consuming maize-based diets, but mean hemoglobin, plasma ferritin, MMA, tHcys, and folate did not differ. Plasma zinc, followed by CRP (< or = 5 mg/L), gravida (< or = 4), and plasma ferritin (> or = 12 microg/L) status were major positive predictors of hemoglobin. Despite some early functional vitamin B-12 deficiency, there was no macrocytic anemia. Consumption of fermented enset may have increased vitamin B-12 levels in diet and plasma.

Prevalence of zinc deficiency and its association with dietary, serum albumin and intestinal parasitic infection among pregnant women attending antenatal care at the University of Gondar Hospital, Gondar, Northwest Ethiopia

“…The result of the present study was relatively similar with study conducted in Southern Ethiopia 53 % [12] and Nepal 61 % [20]. However, relatively lower than other reports from Ethiopia; prevalence of ZD was 76 % [30], 74 % [15] and 72 % [14] in Sidama and 66.7 % [13] in Gondar. It was also relatively lower than study from other countries, Kenya 66.9 % [16], Cameroon 82 % [18], and India 73.5 % [31].…”

“…About 73 (34.9 %) of the subjects had both deficiencies. A previous studies also found significant positive association between zinc deficiency and anemia [12,15,32,46]. As the studies are cross-sectional it is not viable to implicate causal inference.…”

“…Nevertheless, as zinc is known to participate in multiple metabolic pathways, it might have causal role in anemia. This relation between ZD and anemia might be due to the role of zinc in erythropoiesis or the common dietary sources of iron and zinc [15,47,48].…”

“…In Ethiopia, few studies determined the prevalence of ZD in pregnant women and came up with figures ranging from 53 to 76 % [12][13][14][15]. All the studies consistently witnessed the public health significance of ZD in the country.…”

Ethiopian pre-school children consuming a predominantly unrefined plant-based diet have low prevalence of iron-deficiency anaemia

“…Diets of rural Ethiopian populations are predominantly plant based with low intakes of animal-source foods (7) . Researchers have recognized the presence of mild to moderate IDA in lactating (8) and pregnant (9) women, as well as other women of reproductive age (10)(11)(12) , from Ethiopia. Recent studies have shown a high dietary intake of Fe by pregnant women (13) and young children (14) .…”