广西农村儿童维生素A和铁缺乏营养状况关系的调查研究

目的了解广西农村3～12岁儿童血浆维生素A(VA)营养状况、VA缺乏率、VA边缘缺乏率、铁营养状况,分析VA营养状况与铁缺乏的关系。方法分析2002年“中国居民营养与健康状况调查”广西316名3～12岁农村儿童的血浆VA、血红蛋白(Hb)含量。结果广西农村儿童的血浆VA平均含量为(0.91±0.27)μmol/L,Hb平均含量为(127.26±14.50)g/L。VA缺乏与边缘缺乏率分别为25.0%、43.9%;VA含量与Hb含量成正相关(P<0.05,r=0.143);随着VA含量水平降低,贫血患病率升高。结论广西农村儿童VA严重缺乏,同时伴随缺铁性贫血,应引起政府部门的高度重视。在防治儿童缺铁性贫血的同时,还应相应补充VA。     

育龄妇女与儿童转铁蛋白受体的比较研究

目的比较健康儿童和育龄妇女血浆转铁蛋白受体(TfR)、铁蛋白(SF)浓度及TfRSF比值,研究血浆TfR与其它铁营养状况评价指标的相关性。方法以3组健康人群(3～6岁学龄前女童109名,11～12岁青春前期女孩133名,20～45岁育龄妇女115名)为研究对象,比较各组血浆TfR、铁蛋白(SF)浓度及TfRSF比值,研究TfR与SF、血红蛋白(Hb)、总铁结合力(TIBC)及年龄相关性。结果血浆TfR浓度在学龄前女童最高,青春前期女孩次之,育龄妇女最低,分别为(23.34±6.78)、(21.33±5.30)和(19.86±4.83)nmolL。青春前期女孩的血浆SF浓度高于育龄妇女,育龄妇女高于学龄前女童,分别为(60.37±33.39)、(57.17±29.81)和(47.83±24.49)μgL。TfRSF比值在学龄前女童最高,青春前期女孩次之,育龄期妇女最低,分别为(0.72±0.83)、(0.48±0.47)、(0.47±0.37)。多元线性回归分析表明,SF、Hb、年龄对TfR有影响。结论血浆SF、Hb(即使SF、Hb在正常值范围内)及年龄均对TfR有影响,储备铁含量越低SF对TfR的影响越强。儿童血浆TfR含量高于成年人,表明儿童生理性储备铁含量低于成年人。     

儿少卫生

042 8 0 6　学龄儿童维生素A营养状况及其与铁的相关性研究 /林晓明…∥卫生研究 2 0 0 3 ,3 2 (1 ) 1 3～ 1 6为观察学龄儿童维生素A(VA)营养状况、亚临床VA缺乏患病率及VA与铁的相关性 ,对北京房山山区1 0 1 2名 7～ 1 3岁学龄儿童进行膳食调查 ,随机抽取 3 0 5名儿童 ,静脉采血于避光下分离血清 ,用高效液相色谱法检测血清VA含量 ,同时测定其血清铁蛋白 (SF)、红细胞游离原卟啉 (FEP)和血红蛋白 (Hb) ,并依现行标准将其分为正常、铁缺乏 (ID)、红细胞生成缺铁期(IDE)与缺铁性贫血 (IDA)四组 ,观察VA与铁的相关性。结果显…     

学龄儿童维生素A营养状况及其与铁的相关性研究

为观察学龄儿童维生素A(VA)营养状况、亚临床VA缺乏患病率及VA与铁的相关性 ,对北京房山山区 1 0 1 2名 7～ 1 3岁学龄儿童进行膳食调查 ,随机抽取 30 5名儿童 ,静脉采血于避光下分离血清 ,用高效液相色谱法检测血清VA含量 ,同时测定其血清铁蛋白 (SF)、红细胞游离原卟啉 (FEP)和血红蛋白 (Hb) ,并依现行标准将其分为正常、铁缺乏 (ID)、红细胞生成缺铁期 (IDE)与缺铁性贫血 (IDA)四组 ,观察VA与铁的相关性。结果显示受检儿童膳食总能量、蛋白质和铁平均每日摄入量均达到膳食营养素的推荐摄入量 (RNI)及适宜摄入量 (AI) ,但平均每日VA摄入量为 (51 3 7± 2 86 1 ) μgRE ,仅占RNI的 59 7% ;血清VA平均含量为(1 0 1± 0 2 9) μmol L ,血清VA低于 1 0 5μmol L者占受检儿童的 59 0 % ,其中 1 2 8%的儿童血清VA低于0 70 μmol L ,正常及以上者仅占 41 0 %。并观察到血清VA含量与机体铁状况有相互随对方下降而减低的趋势。结果表明 ,该地区儿童存在明显的VA缺乏 ,应加强营养教育、改善不合理的膳食结构并通过适当的VA防治予以纠正     

铁缺乏育龄妇女血清转铁蛋白受体的变化及其诊断铁缺乏效率分析

目的:探讨血清转铁蛋白受体(sTfR)与血清转铁蛋白受体/血清铁蛋白(sTfR/SF)筛检铁缺乏的特异性和灵敏性及其鉴定铁缺乏的效率。方法:初筛北京郊区与河北地区18-45岁非孕育龄妇女941名,检测血清铁蛋白(SF)、锌原卟啉(ZPP)、血红蛋白(Hb),依评价标准,分为铁正常、贮存铁减少(IDS)、红细胞生成缺铁(IDE)与缺铁性贫血(IDA)四组,测定其sTfR值并计算sTfR/SF即sTfR/LogSF、Log(sTfR/SF),观察不同铁状况育龄妇女sTfR、sTfR/SF水平及变化,并采用ROC曲线分析其诊断铁缺乏效率。结果:IDS、IDE、IDA各期sTfR水平随铁缺乏程度显著增加,sTfR/SF在各期增加幅度均较大。sTfR与SF、Hb显著负相关,与ZPP显著正相关。经ROC曲线分析,sTfR鉴定功能铁缺乏的效率可达83%,Log(sTfR/SF)鉴定贮存铁缺乏的效率可达99%。结论:sTfR与sTfR/SF可灵敏反映人体铁状况,可作为筛检育龄妇女铁缺乏的可靠指标。     

贫血孕妇维生素A、维生素B_2和铁营养状况及抗氧化水平的调查分析

目的分析孕期贫血妇女的血浆维生素A(VA)、维生素B2(VB2)和铁营养状况及抗氧化水平。方法将孕中期妇女分成非贫血组(Hb≥110g/L,36人)和贫血组(HB80~105g/L,426人),经知情后同意参加。采用24小时膳食回忆法了解受试者每日主要营养素摄入情况,采集空腹静脉血5ml,分析血浆VA、VB2和铁蛋白(SF)水平,超氧化物歧化酶(SOD)和谷胱甘肽过氧化物酶(GSH-Px)活性,丙二醛(MDA)和红细胞膜流动性的变化。结果贫血孕妇VA、VB2摄入不足,分别为推荐摄入量(RNIs)的58·7%和57·2%,铁的来源仍为吸收率低的植物性食物。贫血孕妇的血浆VA(1·25μmol/L)和铁蛋白(20·57μg/L)水平明显低于非贫血孕妇(VA1·57μmol/L,SF33·16μg/L,P<0·05),全血谷胱苷肽还原酶活性系数(BGRAC)(1·79)水平高于非贫血组(1·52);SOD(77·1U/ml)和GSH-Px(61·9U)活性低于非贫血组(SOD92·2U/ml,GSH-Px71·6U,P<0·05);MDA(4·58nmol/ml)和红细胞膜的P和η值(P=0·2622,η=2·7465)明显高于非贫血组(MDA3·78nmol/ml,P=0·2360,η=2·3658,P<0·05)。且随贫血程度的加重,VA、铁蛋白水平、SOD和GSH-Px活性进一步下降,BGRAC、MDA、P和η值明显升高。结论妊娠中期贫血妇女血浆VA、VB2、铁蛋白及抗氧化能力均明显低于非贫血孕妇。且随贫血程度的加重而降低。     

中国九省农村寄宿制学校初一学生铁营养状况

目的评估北京、广东、广西、浙江、天津、宁夏、四川、上海、山东九省农村寄宿制学校初一学生铁营养状况。方法 2013年多阶段整群抽样方法抽取九省农村寄宿制学校的初中一年级学生,采用生化指标评价铁营养状况,氰化高铁法测定血红蛋白(Hb),参照卫生行业标准WS/T 441—2013筛查贫血。采用免疫比浊法测定血清铁蛋白(SF)、血清转铁蛋白受体(sTfR)和高敏C反应蛋白(hsCRP),计算铁储量(BI),以SF25 ng/mL,sTfR4.4 mg/L且不贫血判定为储存铁缺乏期(SID);以SF25 ng/mL,sTfR4.4 mg/L且不贫血判定为缺铁性红细胞生成期(IDE);以SF25 ng/mL且贫血,判定为铁缺乏贫血(IDA)。以hsCRP5 mg/L排除有炎症或感染的个体。结果共调查1263名年龄范围为10~18岁的初中一年级学生,调查学生的Hb、SF、sTfR和BI水平分别为(144.6±13.2)g/L、52.2 ng/mL、3.34 mg/L和(6.72±2.61)mg/kg。调查对象的贫血率为4.8%,铁缺乏检出率为10.5%,其中SID、IDE和IDA率分别为6.6%、2.5%和1.4%,铁缺乏的每个阶段女生发生率均高于男生。结论寄宿制学校中男生的铁营养状况较好,女生的铁营养状况更应重视,确保膳食铁的充足摄入。     

铁缺乏儿童血清转铁蛋白受体的变化及对铁干预的反应

目的观察血清转铁蛋白受体(sTfR)在铁状况正常和不同程度缺铁儿童体内的水平和铁干预后的变化,评价sTfR在筛检人群铁缺乏和补铁效果中的价值.方法初筛北京房山区6～14岁儿童1006名,检测其铁生化指标,从中筛选铁正常、贮存铁减少(ID)、红细胞生成缺铁(IDE)和缺铁性贫血(IDA)儿童239名,采用双抗体夹心ELISA法测定sTfR含量,计算sTfR/log血清铁蛋白(SF).对铁缺乏儿童给予口服乙二胺四乙酸钠铁胶囊(60mg元素铁/粒),每次1粒,ID与IDE儿童,每周1次,IDA儿童每周3次,连续9周.补铁后重复测定铁生化指标与sTfR,比较补铁前后sTfR的变化.结果ID、IDE、IDA期儿童sTfR含量分别为(20.03±2.33)nmol/L、(24.52±1.07)nmol/L和(33.28±6.09)nmol/L,sTfR/logSF值分别为18.15±5.31、20.98±8.88和29.08±8.57,均显著高于正常对照组的sTfR(18.74±3.06)nmol/L与sTfR/logSF值9.89±1.74.sTfR与红细胞游离原卟啉(FEP)、血红蛋白(Hb)显著相关.正常儿童sTfR为12.5～23.5nmol/L.补铁后,ID、IDE与IDA期儿童sTfR含量为(16.37±3.10)nmol/L,明显低于补铁前水平,但在IDE与IDA期没有变化;ID期儿童sTfR/logSF值分别为11.42±3.12、16.54±4.70和23.59±9.93,与补铁前相比均显著降低.结论sTfR为鉴定铁缺乏IDE与IDA期的特异指标,sTfR/logSF为观察补铁效果的敏感指标.     

血清转铁蛋白受体在小儿缺铁性贫血诊断及分度中的研究

目的:探讨血清转铁蛋白受体(sTfR)在儿童缺铁性贫血(IDA)诊断及其分度中的意义。方法:6月-12岁IDA儿童50例及正常儿童20例均进行血红蛋白(Hb)、sTfR、血清铁蛋白(SF)、血清铁(SI)、总铁结合力(TIBC)测定,并将受测对象分为正常对照组(C组)、轻度IDA组(IDA1组)、中一重度IDA组(IDA2组),计算C组、IDA1组、IDA2组3组间sTfR均数并将其进行统计学分析比较。结果:C组、IDA1组、IDA2组sTfR浓度分别为27.6±9.3 nmol／L、44.3±8.5 nmol／L、63.4±12.6 nmol／L,将其3组间进行方差分析及两两比较,均有显著差异(P<0.01)。结论:sTfR在诊断IDA及判断IDA的严重程度中有着重要的意义。     

铁缺乏致网织红细胞参数及血清转铁蛋白受体的变化

目的研究早期铁缺乏的敏感指标。方法根据铁蛋白(SF)、血红蛋白(Hb)、血清铁(SI),将12～15岁289位女性分组:铁耗竭期(SID期),红细胞生成缺铁期(IDE期),缺铁性贫血期(IDA期)和对照组。检测各组网织红细胞参数[包括网织红细胞百分比(Ret%)、低荧光强度网织红细胞(LFR)、中荧光强度网织红细胞(MFR)、高荧光强度网织红细胞(HFR)和网织红细胞成熟指数(RMI)、血清转铁蛋白受体(sTfR)和红细胞参数[(包括红细胞分布宽度(RDW%)和红细胞平均容积(CMV)),比较各组的指标,以及sTfR同其他指标的相关关系。结果 HFR和sTfR在SID期、IDE期、IDA期均显著高于对照组(P<0.01),并且呈数倍增长;MFR、RMI、RDW%和MCV在SID期与正常对照组无显著性差异(P>0.05),而IDE期和IDA期均与对照组有显著性差异(P<0.01或P<0.05),其中MFR和RMI呈数倍改变。sTfR和HFR、MFR以及RMI呈明显正相关(r=0.51,0.57,0.64,P<0.05),同Hb呈明显负相关(r=-0.54,,P<0.01);同SF、SI相关性微弱(r=-0.30,-0.31,P<0.05)。结论 HFR、sTfR、MFR、RMI可作为早期铁缺乏的诊断指标,尤其是前二者,可在铁缺乏患者的筛查中推广应用。[营养学报,2013,35(2):150-153]     

Anaemia and iron deficiency among adolescent schoolgirls in peri-urban Bangladesh

OBJECTIVE: To investigate the prevalence of anaemia and iron deficiency among adolescent schoolgirls in peri-urban Bangladesh, and to identify various factors associated with anaemia in this population. DESIGN: A cross-sectional design. SETTING: Girls' high schools in five sub-districts of Dhaka. SUBJECTS: Adolescent girls (n=548) aged 11-16 y from nine schools in Dhaka district participated in the study. Socio-economic, anthropometric and dietary information were collected. Blood haemoglobin (Hb), serum iron, total iron binding capacity (TIBC), transferrin saturation (TS), serum ferritin (SF) and serum retinol (vitamin A) were determined. RESULTS: The prevalence of anaemia (Hb<120 g/l) among the participants was 27%. Seventeen percent had depleted iron stores (SF<12 microg/l). Of all anaemic girls, 32% had iron deficiency anaemia (Hb<120 g/l and SF<12 microg/l). When the girls were classified by serum vitamin A, the third with the lowest serum retinol levels had significantly lower Hb and SF levels. Significant positive correlations were observed between Hb and serum iron, TS, SF and retinol, while there was a negative correlation with serum TIBC. Occupancy, frequency of consumption of large fish, serum iron, TIBC, TS, SF and serum vitamin A were strongly related to Hb by multiple regression analysis. For 1 microg/l change in SF concentration, there was a 0.046 g/l change in Hb, when adjusted for all other factors. CONCLUSION: Anaemia among these adolescent schoolgirls in peri-urban Bangladesh cannot be explained by iron deficiency alone, and other causes may also exist in this population.     

Response of hemoglobin, serum ferritin, and serum transferrin receptor during iron supplementation in pregnancy: a prospective study

OBJECTIVE: We evaluated the effect of iron supplementation on biochemical indicators of iron status, namely hemoglobin (Hb), serum ferritin (SF), and serum transferrin receptor (sTfR), during pregnancy. METHODS: A prospective study was conducted in 73 pregnant women who received daily supplements of 60 mg of iron and 500 microg of folic acid for 100 d from 19 wk of gestation. The indicators of iron status (Hb, SF, and sTfR) at 19, 27, and 35 wk of gestation were analyzed. The response of iron status indicators to iron supplementation was assessed in the cohort and in pregnant women who were anemic (n = 35) and non-anemic (n = 38) at 19 wk. RESULTS: All three indicators of iron status during supplementation (27 and 35 wk) were similar to the presupplementation status. The sTfR as an indicator correlated negatively with presupplementation Hb levels (r = -0.417). Based on sTfR level in iron-adequate pregnant women, a cutoff value of at least 12.0 mg/L was derived to define iron deficiency in pregnancy. When the response was tested in anemic pregnant women, iron supplementation improved mean Hb (P < 0.05) at the end of 35 wk (96 +/- 8.8 to 110 +/- 20.2 g/L) of gestation, with no change in SF. Conversely, non-anemic pregnant women showed a significant increase in SF and a decrease in Hb (122 +/- 11.6 to 112 +/- 15.2 g/L) at 35 wk of gestation. A significant effect of iron intake on sTfR was seen only among iron-deficient anemic women. CONCLUSIONS: These observations suggest that, during pregnancy, sTfR responds to iron supplementation when there is iron-deficiency anemia and therefore can be used as an indicator.     

Genetic hemoglobin disorders, infection, and deficiencies of iron and vitamin A determine anemia in young Cambodian children

In Cambodia, many factors may complicate the detection of iron deficiency. In a cross-sectional survey, we assessed the role of genetic hemoglobin (Hb) disorders, iron deficiency, vitamin A deficiency, infections, and other factors on Hb in young Cambodian children. Data on sociodemographic status, morbidity, and growth were collected from children (n = 3124) aged 6 to 59 mo selected from 3 rural provinces and Phnom Penh municipality. Blood samples were collected (n = 2695) for complete blood count, Hb type (by DNA analysis), ferritin, soluble transferrin receptor (sTfR), retinol-binding protein (RBP), C-reactive protein, and α(1)-acid glycoprotein (AGP). Genetic Hb disorders, anemia, and vitamin A deficiency were more common in rural than in urban provinces (P < 0.001): 60.0 vs. 40.0%, 58.2 vs. 32.7%, and 7.4 vs. 3.1%, respectively. Major determinants of Hb were age group, Hb type, ferritin, sTfR, RBP, AGP >1.0 g/L (P < 0.001), and rural setting (P < 0.05). Age group, Hb type, RBP, elevated AGP, and rural setting also influenced ferritin and sTfR (P < 0.02). Multiple factors affected anemia status, including the following: age groups 6-11.99 mo (OR: 6.1; 95% CI: 4.3, 8.7) and 12-23.99 mo (OR: 2.7; 95% CI: 2.1, 3.6); Hb type, notably Hb EE (OR: 18.5; 95% CI: 8.5, 40.4); low ferritin (OR: 3.2; 95% CI: 2.2, 4.7); elevated AGP (OR: 1.4; 95% CI: 1.2,1.7); rural setting (OR: 2.3; 95% CI: 1.7, 3.1); low RBP (OR: 3.6; 95% CI: 2.2, 5.9); and elevated sTfR (OR: 2.1; 95% CI: 1.7, 2.7). In Cambodia, where a high prevalence of genetic Hb disorders exists, ferritin and sTfR are of limited use for assessing the prevalence of iron deficiency. New low-cost methods for detecting genetic Hb disorders are urgently required.     

Iron and vitamin A deficiency in long-term African refugees

Five cross-sectional surveys were conducted in African refugee camps to assess the level of iron deficiency anemia and vitamin A deficiency in populations dependent on long-term international food aid and humanitarian assistance. The prevalence of anemia in children [hemoglobin (Hb) <110 g/L] was high, with >60% affected in 3 of 5 camps. Iron deficiency [serum transferrin receptor (sTfR) >8.5 mg/L] was also high, ranging from 23 to 75%; there was also a strong ecological correlation between the prevalence of iron deficiency and anemia among different camps. Within camps, sTfR predicted the concentration of Hb with adjusted R(2) values ranging from 0.19 to 0.51. Although children were more affected, anemia was also a public health problem in adolescents and women. The effect of recent recommendations on Hb cutoff values for African populations was assessed and found to produce decreases in the prevalence of anemia of between 5 and 21%; this did not affect the public health categorization of the anemia problem within the most affected camps. Mean serum retinol in children, after adjustment for infection status, ranged from 0.72 +/- 0.2 to 0.88 +/- 0.2 micromol/L in the 4 camps assessed and vitamin A deficiency (<0.7 micromol/L) was present at levels ranging from 20.5 to 61.7%. In areas in which vitamin A capsule distribution programs were in effect, coverage ranged from 3.5 up to 66.2%. The high level of micronutrient deficiencies seen in long-term refugees argues in favor of further enhancements in food aid fortification and the strengthening of nutrition and public health programs.     

Evaluation of serum transferrin receptor for iron deficiency in women of child-bearing age

The objective was to study the evaluation of serum transferrin receptor (sTfR) for Fe deficiency in women of child-bearing age. Primary screening was performed in 942 women ranging in child-bearing age. Serum ferritin (SF), Zn protoporphyrin (ZPP) and Hb were determined. Then the subjects were divided into four groups: normal, Fe store depletion (IDs), Fe-deficiency erythropoiesis and Fe-deficiency anaemia. sTfR was determined and sTfR/SF (sTfR/logSF and log(sTfR/SF)) was calculated. Changes of sTfR in women of different Fe status were observed. A receiver-operating characteristic (ROC) curve was used to evaluate whether sTfR had proper diagnostic efficacy for functional Fe deficiency. The levels of sTfR increased significantly along with the aggravation of Fe deficiency. Increase of STfR/SF along with the aggravation of Fe deficiency was more significant than that of sTfR. STfR had a significant negative correlation with SF and Hb, while it had a significant positive correlation with ZPP. The ROC curve showed that the diagnostic effective rate of sTfR for Fe deficiency could reach 83 %. At this point, the sensitivity was 79 % and the specificity was 63 %. Log(sTfR/SF) could be considered to have the highest effective ratio in detecting IDs, since it reached 99 %. STfR and sTfR/SF could both reflect body Fe-deficiency status specifically. They could be used as reliable indicators for evaluating Fe status and diagnosing Fe deficiency in women of child-bearing age.     

The assessment of frequency of iron deficiency in athletes from the transferrin receptor-ferritin index

The transferrin receptor-ferritin index (sTfR/logFerr) was determined in 131 male and 121 female athletes in order to assess the frequency of iron deficiency (threshold value of that index taken as 1.8). Blood was drawn for determining morphological indices as well as sTfR, ferritin, iron, total iron binding capacity (TIBC), and haptoglobin. A significantly (p <.01) higher incidence of iron deficiency was observed in women (26%) than in men (11%). The iron deficiency was latent, since no subject was found to be anemic. The plasma iron was significantly lower and TIBC higher (p <.001) in both iron-deficient subgroups than in the non-deficient ones. This confirmed the latent character of iron deficiency. Some hematological indices (Hb, MCH, MCHC, MCV) were significantly lower in iron-deficient female athletes than in male athletes, which suggested a more profound iron deficiency in the former. The sTfR/logFerr index might thus be useful in detecting iron deficiency in athletes, especially in those with erythropoiesis disorders, since physical loads may affect the widely used ferritin levels.     

Predictors of serum ferritin and serum soluble transferrin receptor in newborns and their associations with iron status during the first 2 y of life

BACKGROUND: Adequate iron status at birth may prevent iron deficiency in early childhood. OBJECTIVES: We aimed to identify predictors of serum ferritin (SF) and serum soluble transferrin receptor (sTfR) in healthy newborns and to relate these iron indexes to iron status in the first 2 y of life. DESIGN: Using bivariate correlations and linear regression, we related various factors in pregnancy to SF (n=363) and sTfR (n=350) in healthy, term infants. Measurements of cord SF and sTfR were compared with those of SF and sTfR at 6, 12, and 24 mo. All 4 measurements were available for 191 and 169 infants for SF and sTfR, respectively. RESULTS: Geometric mean (and 95% CI) cord SF and sTfR measurements were 159 (148, 171) microg/L and 7.3 (7.0, 7.6) mg/L, respectively. Cord SF correlated with sTfR (rho=-0.21, P<0.001). In regression analysis, cord SF correlated with smoking and the use of iron supplements during pregnancy (partial r=-0.12 and 0.16; P<0.05 for both). Cord sTfR was associated with first trimester BMI, gestational age, and male sex (partial r=0.30, 0.24, and 0.19, respectively; P<0.01 for all). Cord SF correlated with SF at 6, 12, and 24 mo (rho=0.45, 0.31, and 0.16 respectively; P<0.05 for all). At age 6 mo, 16 of 17 infants with SF <15 mug/L were boys. CONCLUSIONS: Cessation of smoking and adequate iron prophylaxis during pregnancy may improve iron status in infancy. Cord SF is a predictor of iron status in the first 2 y of life. Boys are at particular risk of low iron status in early infancy.