(P24-077-24) Micronutrients Associated With Anemia in School Age Children and Adolescents: BRINDA Project

Objectives: School age children and adolescents are at risk for anemia through demands on micronutrients required for growth and maturation. This multi-country analysis examined the burden of anemia in children 5-19y by sex and age category and associations with inflammation and micronutrient deficiencies.

Methods: Children 5-19y from surveys in the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project were included with measured hemoglobin, at least one 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 selected for multivariable models. The attributable burden of anemia was examined by age category for each factor using multivariable modified Poisson regression with robust standard errors.

Results: This analysis included 54,535 children from 17 surveys. Median anemia prevalence was 16% (range: 5-59%). In most surveys, anemia did not differ by sex for children 5-14y and was lower in children 10-14y than 5-9y or 15-19y. A 1y increase in age was inversely associated with anemia in children 5-9y [prevalence ratio (PR) range: 0.6-0.9] and positively in children 10-14y but not 15-19y. Inflammation was positively associated with anemia in all age groups [5-9y (4 of 4 surveys); 10-14y (2 of 4 surveys); 15-19y (6 of 8 surveys)]. Iron deficiency was frequently associated with anemia, often with the highest PRs of examined factors [15-19y (PRs with P < 0.05: 1.6-14.2; 12 of 14 surveys); 10-14y (2.1-6.5; 5 of 6 surveys); 5-9y (1.8-2.9; 4 of 7 surveys). Vitamin A deficiency was also associated with anemia [5-9y (2 of 2 surveys); 10-14y (2 of 3 surveys); 15-19y (2 of 3 surveys)]. Data for folate, vitamin B₁₂, and zinc were sparce and often unassociated with anemia.

Conclusions: Iron deficiency was consistently associated with anemia in studies of school age children and adolescents. This research underscores the importance of examining micronutrients associated with anemia in context of factors like country, age, and sex.

Funding Sources: Bill & Melinda Gates Foundation, Centers for Disease Control and Prevention, Eunice Kennedy Shriver National Institute of Child Health and Human Development, HarvestPlus, and the United States Agency for International Development