Factors associated with the iron nutritional status of Brazilian children aged 4 to 7 years

ANDRÉ, Hercílio Paulino; VIEIRA, Sarah Aparecida; FRANCESCHINI, Sylvia do Carmo Castro; RIBEIRO, Andréia Queiroz; HERMSDORFF, Helen Hermana Miranda; PRIORE, Silvia Eloiza

doi:10.1590/1678-98652017000300007

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Sumário

ORIGINAL ARTICLES • Rev. Nutr. 30 (03) • May-Jun 2017 • https://doi.org/10.1590/1678-98652017000300007 copy

Factors associated with the iron nutritional status of Brazilian children aged 4 to 7 years

Fatores associados ao estado nutricional de ferro em crianças brasileiras de 4 a 7 anos

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To evaluate factors associated with the iron nutritional status of Brazilian children aged 4 to 7 years in the city of Viçosa, Minas Gerais state, Brazil.

Methods

This is a cross-sectional study of 357 children aged 4-7 years who had been followed-up up for during their first six months of life by the Breastfeeding Support Program. Socioeconomic and demographic characteristics, feeding practices, nutritional status (height-for-age and body mass index-for-age), and serum ferritin and hemoglobin concentrations were evaluated. Multiple linear regression analysis was carried out to evaluate factors independently associated with iron nutritional status (hemoglobin and ferritin), considering α=0.05 as the significance level.

Results

The prevalence of anemia and iron deficiency was (34) 9.52% and (11) 11.00%, respectively. The factors independently associated with anemia were younger child age, low maternal education, low height-for-age Z-scores, and children of single and separated mothers or widows. Iron deficiency was associated with child younger age and consumption of chocolates and chocolate flavored milk.

Conclusion

The results obtained allow us to conclude that anemia among children 4-7 years of age is a public health problem in the city of Viçosa, Minas Gerais. Therefore, there is a need for intervention measures targeting children in this age group. These measures can be implemented through food and nutritional education by encouraging the consumption of iron-rich foods.

Keywords:
Anemia; Child; Iron deficiency; Iron-deficiency anemia

Variable	^* Hemoglobin (g/dL)						^** Serum ferritin (µg/L)
Variable	n	%	M	±	SD	p ^a	n	%	Med.	Min.	Max.	p ^b
Gender
Male	190	53.22	12.51	±	0.78	<0.170	48	48.00	23.00	03.30	51.00	0.01
Female	167	46.78	12.63	±	0.85		52	52.00	31.00	03.10	74.20
Maternal age ^1,2
<20 years	53	15.06	12.63	±	0.92	<0.480	15	15.00	27.70	14.00	63.40	0.61
≥20 years	299	84.94	12.54	±	0.81		85	85.00	26.60	03.10	74.20
Maternal education ^3,4
≤8 years	136	38.31	12.48	±	0.86	<0.150	31	31.00	27.50	03.10	73.40	0.54
>8 years	220	61.69	12.61	±	0.78		69	69.00	26.90	03.30	74.20
Paternal education ^5,6
≤8 years	174	53.54	12.54	±	0.85	<0.280	45	49.45	27.80	03.10	74.20	0.65
>8 years	151	46.46	12.64	±	0.78		46	50.55	25.85	08.50	73.20
Paternal employment ^7,8
Formal	245	68.82	12.56	±	0.83	<0.910	65	65.00	27.80	03.10	74.20	0.75
Informal	111	31.18	12.55	±	0.80		35	35.00	24.50	14.00	51.00
Maternal marital status ^9,10
Single, separated, widow	74	20.79	12.31	±	0.82	<0.001	27	27.00	31.90	14.00	63.40	0.34
Married or domestic relationship	282	79.21	12.63	±	0.81		73	73.00	25.70	03.10	74.20
Per capita income ^11,12
≤1/4 of the minimum wage	79	22.51	12.40	±	0.93	<0.040	10	10.53	23.80	15.80	73.40	0.57
>1/4 of the minimum wage	272	77.49	12.62	±	0.78		85	89.47	27.50	03.10	74.20

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[1] Correspondência para/Correspondence to: SE PRIORE. E-mail: <sepriore@gmail.com>.

Variable	Hemoglobin (g/dL)						Serum ferritin (µg/L)
Variable	n	%	X	±	SD	p ^a	n	%	Med.	Min.	Max.	p ^b
Chocolates/chocolate flavored milk ^1,2
Yes	351	98.60	12.560	±	0.820	0.23	97	97.98	26.30	03.10	73.40	0.18
No	5	01.40	13.000	±	0.400		2	02.02	51.00	27.80	74.20
Soft drink ^3,4
Yes	347	97.47	12.550	±	0.820	0.17	93	93.94	26.90	03.10	73.40	0.98
No	9	02.53	12.933	±	0.587		6	06.06	27.15	08.50	74.20
Fruits ^5,6
Yes	351	98.87	12.570	±	0.820	0.16	96	96.94	26.90	03.30	74.20	0.59
No	4	01.13	12.000	±	0.840		3	03.06	27.70	03.10	34.80
Dark green leafy vegetables ^7,8
Yes	341	95.79	12.560	±	0.820	0.88	89	89.90	27.80	03.10	74.20	0.04
No	15	04.21	12.500	±	0.660		10	10.10	23.20	12.70	34.80
Milk and other dairy products [yogurt, cheese, and requeijão (a loose, ricotta-like cheese)] ^9,10
Yes	351	98.60	12.560	±	0.820	0.72	96	96.97	26.00	03.10	73.40	0.02
No	5	01.40	12.700	±	0.560		3	03.03	46.30	34.80	74.20
Legumes (beans)
Yes	-	-		-		-	95	97.94	27.40	03.10	74.20	0.02
No	-	-		-		-	2	02.06	08.65	03.30	14.00

Variables	Hemoglobin (g/dL)			Serum ferritin (µg/L)
Variables	r	p-valor	r	p-valor
Current child weight	0.19^a	<0.001	0.21^a	<0.030
Current child height	0.20^b	<0.001	0.18^a	<0.060
Child height-for-age (Z-score)	0.15^b	<0.001	0.02^a	<0.770
Current child age	0.18^a	<0.001	0.32^a	<0.001
Current maternal age	0.17^a	<0.001	0.05^a	<0.560

Variable	Hemoglobin (g/dL)			Variable	^* Serum ferritin (µg/L)
Variable	β	95%CI	p-value		β	95%CI	p-value
Child age	-0.01	0.00-0.01	<0.001	Child age	-0.04	-0.02-0.07	<0.001
Maternal education	-0.03	0.00-0.05	<0.010	Consumption of chocolates/chocolate flavored milk
Height-for-age (Z-score)	-0.09	0.01-0.18	<0.020	Yes	-2.32	-4.05-(-0.59)	<0.001
Marital status				No	-	-
Married or domestic partnership	-	-
Single, separated, widow	-0.32	-0.11-(-0.52)	<0.001