Abstract
OBJECTIVES: In Rwanda, anemia affects 38% of all under five and 61% of those aged 9–11 months old; however, the contribution of diet to anemia remains less known. This study aimed to assess if dietary iron intake predicts the risk of anemia and iron deficiency among Rwandan children of 12 months old. METHODS: A longitudinal study of 192 children was conducted in 2016–2018 in a rural setting in Rwanda. We measured hemoglobin concentration, and collected blood samples from the infant-mother pairs at birth, 4 and 12 months post-partum. Plasma or serum ferritin, soluble transferrin receptors (sTfR), C-reactive protein (CRP), and α-Acid Glycoprotein (AGP) concentrations were measured using sandwich ELISA technique. Body iron stores were calculated from the sTfR/Ferritin ratio. Hemoglobin and ferritin values were adjusted for altitude and infection, respectively. Dietary iron intake data were collected using a full 24-hour recall, and the intake of iron from micronutrient powders was captured by questionnaire. Predictors of anemia, iron deficiency, and iron deficiency anemia at 12 months of age were modelled using Cox proportional hazard regression with robust variance. RESULTS: Anemia, iron deficiency (ID), and iron deficiency anemia (IDA) occurred in 73%, 56%, and 44% of the infants at 4 months, and 48%, 88% and 45% of the children at 12 months, respectively. For their mothers, anemia, ID, and IDA occurred in 12%, 59%, and 9% at 4 months, and 12%, 49%, and 8% at 12 months. Child's dietary iron intake did not significantly predict anemia [PR = 1.00 (0.96–1.04)], ID [PR = 0.99 (0.98–1.01)], or IDA [PR = 0.99 (0.95–1.03)] at 12 months. However, this study revealed that the child's hemoglobin concentration at birth was inversely associated with anemia at 12 months [PR = 0.92 (0.86–0.99)], whereas inflammation [PR = 1.23 (1.03–1.46)] and IDA at 4 months [PR = 1.44 (1.04–1.99)] increased the risk of anemia at 12 months. Presence of inflammation additionally predicted risk of IDA at 12 months [PR = 1.27 (1.05–1.54)]. CONCLUSIONS: While dietary iron intake is not a significant predictor of anemia, 94% of anemia cases coincide with ID at 12 months of age. In addition, inflammation is the most important predictor of anemia and IDA at this age. Therefore, prevention of inflammation is crucial to make dietary measures effective. FUNDING SOURCES: Embassy of the Kingdom of the Netherlands in Rwanda; UNICEF Rwanda; Nuffic.