Micronutrients Associated With Anemia in School-age Children and Adolescents 2005–2018: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) Project

Abstract

Background

School-age children and adolescents may be at risk of anemia through demands on micronutrients required for growth and maturation.

Objectives

This multicountry analysis examined the burden of anemia in children aged 5–19 y by sex and age category and associations with micronutrient deficiencies, inflammation, and BMI.

Methods

Children aged 5–19 y from surveys in the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) Project were included with hemoglobin, ≥1 micronutrient (iron, vitamin A, folate, vitamin B₁₂, or zinc) and inflammation biomarker, and n > 100 per survey. Factors with bivariate relationships with anemia (P < 0.1) were included in multivariable modified Poisson regression models to examine the attributable burden of anemia.

Results

This analysis included 54,534 children from 17 surveys in 16 countries (16 surveys for 15–19 y; 9 surveys for 10–14 y; 8 surveys for 5–9 y). Median overall anemia prevalence was 16% (range: 5% in Ecuador, United Kingdom, and United States to 59% in Côte d’Ivoire) with the highest burden in 15–19-y-old females (24%). In most surveys, anemia prevalence did not differ by sex for children aged 5–14 y, and median anemia prevalence was lower in children aged 10–14 y (7%) than in those aged 5–9 y (9%) or 15–19 y (22%). In most surveys, higher anemia prevalence was associated (P < 0.05) with iron deficiency (15%) [prevalence ratio (PR): 1.6–14.2; 5–9 y, 4/7 surveys; 10–14 y, 6/6 surveys; 15–19 y, 13/14 surveys), vitamin A deficiency (2%) (PR: 1.8–3.0; 5–9 y, 2/2 surveys; 10–14 y, 2/3 surveys; 15–19 y, 2/3 surveys), and inflammation (13%) (PR: 1.4–2.4: 5–9 y, 4/4 surveys; 10–14 y, 2/4 surveys; 15–19 y, 6/8 surveys). Folate, vitamin B₁₂, zinc, and BMI had weak, variable associations with anemia.

Conclusions

Iron deficiency and vitamin A deficiency are consistently associated with anemia in school-age children and adolescents, whereas inflammation and other micronutrients had context-dependent associations. This research underscores the importance of examining multiple micronutrients associated with anemia in the context of factors such as country, age, and sex.