Poster Topical Area: Global Nutrition

Location: Hall D

Poster Board Number: 581

P12-065 - Anemia in women and children in Uttar Pradesh: a path analysis of the associations between nutritional, environmental, infectious, and genetic determinants

Sunday, Jun 10
8:00 AM – 6:00 PM

Objectives: Reducing anemia by 50% in women is a WHA Global Nutrition Target for 2025 but progress to its achievement may be constrained if programs are not responsive to specific causes of anemia. We examined the contribution of nutritional, environmental, infectious, and genetic determinants of anemia in rural and urban women and children living in Uttar Pradesh (UP), India.

Methods: We conducted a state-representative, cross-sectional survey of rural and urban households in 25 districts of UP between October and December 2016. We collected information on socio-economic factors, diet, water, sanitation and hygiene (WASH), household hunger, anthropometry, stool, and venous blood in 1238 non-pregnant women 18-49 years and children 6-59 months of age. We analyzed venous samples for malaria, hemoglobin (Hb), ferritin, transferrin receptor, hepcidin, retinol, folate, zinc, vitamins B12 and D, C-reactive protein (CRP), α1-acid glycoprotein (AGP), and β-thalassemia. We used structural equation modeling to examine the pathways through which thalassemia, diet, household hunger, WASH, inflammation, and biomarkers of nutritional status are associated with Hb concentration. Models showed adequate fit and we reported standardized coefficients.

Results: 36% of women and 56% of children were anemic; 27-46% had iron deficiency. In women and children, ferritin was the strongest predictor of Hb (standardized β=0.52 and 0.46, respectively); red blood cell folate was negatively associated with Hb. In women only, vitamin B12 was associated with Hb. In both populations, CRP but not AGP, was associated with hepcidin, which in turn was indirectly associated with Hb through ferritin. Better WASH practices were positively associated with dietary diversity and negatively associated with household hunger; WASH was indirectly associated with Hb through AGP. Prevalence of malaria (<1%) and intestinal parasites (<9%) was minimal.

Conclusions: In this population, we found a strong association between Hb and iron, and Hb and inflammation. Over 70% of women and children with anemia have iron deficiency anemia, which urgently needs to be addressed. However, complementary interventions may be needed, given the multiple other significant causes identified in this analysis.

Funding Source: Bill and Melinda Gates Foundation through the Global Alliance for Improved Nutrition

CoAuthors: Tinku Thomas – St John's Research Institute; Anura Kurpad – St John's Research Institute; Reynaldo Martorell – Emory University; John Hoddinott – Cornell University; Sumathi Swaminathan – St John's Research Institute; Lynnette Neufeld – Global Alliance for Improved Nutrition

Leila Larson

Research Fellow
University of Melbourne, Australia
North Melbourne, Victoria, Australia

Maternal and child malnutrition, particularly anemia and its implications for child health, growth and development are central to Leila Larson’s research interests. She has worked in various countries worldwide, including Laos, Lebanon, Ethiopia, Bangladesh, Malawi, and India. Leila Larson received her Ph.D. in Nutrition and Health Sciences at Emory University. Her dissertation focused on consequences of malnutrition and effects on child development. As part of her Ph.D. research, she worked on an effectiveness trial to examine the impact of home fortification with multiple micronutrient powders on anemia and child development. Leila Larson has also worked with the Global Alliance for Improved Nutrition on an evaluation of a Double Fortified Salt program in Uttar Pradesh, India. Through her research in South Asia and her work with the Biomarkers Reflecting the Inflammation and Nutritional Determinants of Anemia (BRINDA) collaboration, she has pursued her interest in the etiology of anemia to examine the contribution of nutritional, genetic, infectious, and environmental causes of anemia in women and children. Leila is now a post-doctoral fellow in the Department of Medicine at the University of Melbourne, Australia, and is working on the effects of iron on maternal and child health and development.