Micronutrient deficiencies are common in 6- to 8-year-old children of rural Nepal, with prevalence estimates modestly affected by inflammation

J Nutr. 2014 Jun;144(6):979-87. doi: 10.3945/jn.114.192336. Epub 2014 Apr 17.

Abstract

Subclinical micronutrient deficiencies remain a hidden aspect of malnutrition for which comprehensive data are lacking in school-aged children. We assessed the micronutrient status of Nepalese children, aged 6 to 8 y, born to mothers who participated in a community-based antenatal micronutrient supplementation trial from 1999 to 2001. Of 3305 participants, plasma indicators were assessed in a random sample of 1000 children. Results revealed deficiencies of vitamins A (retinol <0.70 μmol/L, 8.5%), D (25-hydroxyvitamin D <50 nmol/L, 17.2%), E (α-tocopherol <9.3 μmol/L, 17.9%), K (decarboxy prothombin >2 μg/L, 20%), B-12 (cobalamin <150 pmol/L, 18.1%), B-6 [pyridoxal-5'-phosphate (PLP) <20 nmol/L, 43.1%], and β-carotene (41.5% <0.09 μmol/L), with little folate deficiency (6.2% <13.6 nmol/L). Deficiencies of iron [ferritin <15 μg/L, 10.7%; transferrin receptor (TfR) >8.3 mg/L, 40.1%; TfR:ferritin >500 μg/μg, 14.3%], iodine (thyroglobulin >40 μg/L, 11.4%), and selenium (plasma selenium <0.89 μmol/L, 59.0%) were observed, whereas copper deficiency was nearly absent (plasma copper <11.8 μmol/L, 0.7%). Hemoglobin was not assessed. Among all children, 91.7% experienced at least 1 micronutrient deficiency, and 64.7% experienced multiple deficiencies. Inflammation (α-1 acid glycoprotein >1 g/L, C-reactive protein >5 mg/L, or both) was present in 31.6% of children, affecting the prevalence of deficiency as assessed by retinol, β-carotene, PLP, ferritin, TfR, selenium, copper, or having any or multiple deficiencies. For any nutrient, population deficiency prevalence estimates were altered by ≤5.4% by the presence of inflammation, suggesting that the majority of deficiencies exist regardless of inflammation. Multiple micronutrient deficiencies coexist in school-aged children in rural Nepal, meriting more comprehensive strategies for their assessment and prevention.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anemia, Iron-Deficiency / blood
  • Anemia, Iron-Deficiency / drug therapy
  • Anemia, Iron-Deficiency / epidemiology*
  • C-Reactive Protein / metabolism
  • Child
  • Copper / administration & dosage
  • Copper / blood
  • Copper / deficiency
  • Cross-Sectional Studies
  • Dietary Supplements
  • Female
  • Ferritins / blood
  • Folic Acid Deficiency / blood
  • Folic Acid Deficiency / drug therapy
  • Folic Acid Deficiency / epidemiology*
  • Hemoglobins / metabolism
  • Humans
  • Inflammation / blood
  • Inflammation / epidemiology*
  • Logistic Models
  • Male
  • Micronutrients / administration & dosage
  • Micronutrients / blood*
  • Micronutrients / deficiency*
  • Nepal / epidemiology
  • Nutritional Status
  • Prevalence
  • Receptors, Transferrin / blood
  • Receptors, Transferrin / deficiency
  • Rural Population*
  • Selenium / administration & dosage
  • Selenium / blood
  • Socioeconomic Factors
  • Vitamin A / administration & dosage
  • Vitamin A / blood
  • Vitamin D / administration & dosage
  • Vitamin D / analogs & derivatives
  • Vitamin D / blood
  • alpha-Tocopherol / administration & dosage
  • alpha-Tocopherol / blood

Substances

  • Hemoglobins
  • Micronutrients
  • Receptors, Transferrin
  • Vitamin A
  • Vitamin D
  • Copper
  • C-Reactive Protein
  • Ferritins
  • 25-hydroxyvitamin D
  • alpha-Tocopherol
  • Selenium