The Journal of Nutrition Community and International Nutrition Age, Ethnicity, Glucose-6-Phosphate Dehydrogenase Defciency, Micronutrient Powder Intake, and Biomarkers of Micronutrient Status, Infection, and Infammation Are Associated with Anemia Among Children 6–59 Months in Nepal Nicole D Ford, 1 RP Bichha, 2 Kedar Raj Parajuli, 2 Naveen Paudyal, 3 Nira Joshi, 4 Ralph D Whitehead, Jr, 1 Stanley Chitekwe, 3 Zuguo Mei, 1 Rafael Flores-Ayala, 1 Debendra P Adhikari, 5 Sanjay Rijal, 3 and Maria Elena Jefferds 1 1 Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, United States Centers for Disease Control and Prevention, 4770 Buford Hwy NW, Atlanta, GA, 30341, USA; 2 Nepal Ministry of Health and Population, Kathmandu 44600, Nepal; 3 Nutrition Section, United Nations Children’s Fund (UNICEF), Leknath Marg, Kathmandu 44600, Nepal; 4 New ERA, Rudramati Marg, Kalopul, Kathmandu 44600, Nepal; and 5 United States Agency for International Development (USAID), Maharajgunj, Kathmandu 44600, Nepal ABSTRACT Background: Anemia is a major concern for children in Nepal; however, little is known about context-specifc causes of anemia. Objective: We used cross-sectional data from the 2016 Nepal National Micronutrient Status Survey to evaluate factors associated with anemia in a nationally representative, population-based sample of children 6–59 mo (n = 1367). Methods: Hemoglobin, biomarkers of iron status and other micronutrients, infection, infammation, and blood disorders were assessed from venous blood samples. Soil-transmitted helminth (STH) and Helicobacter pylori infections were assessed from stool. Anthropometry was measured with standard procedures. Sociodemographic and household characteristics, diet, micronutrient powder (MNP) intake, pica, and morbidity recall were ascertained by caregiver interview. Multivariable logistic regression that accounted for complex sampling design, determined predictors of anemia (hemoglobin <11.0 g/dL, altitude adjusted); candidate predictors were variables with P < 0.05 in bivariate models. Results: Anemia prevalence was 18.6% (95% CI: 15.8, 21.4). MNP intake [adjusted OR (AOR): 0.25, 95% CI: 0.07, 0.86], log (ln) ferritin (μg/L) (AOR: 0.49, 95% CI: 0.38, 0.64), and ln RBP (μmol/L) (AOR: 0.42, 95% CI: 0.18, 0.95) were associated with reduced odds of anemia. Younger age (6–23 mo compared with 24–59 mo; AOR: 2.29, 95% CI: 1.52, 3.46), other Terai ethnicities (AOR: 2.59, 95% CI: 1.25, 5.35) and Muslim ethnicities (AOR: 3.15, 95% CI: 1.30, 7.65) relative to Brahmin/Chhetri ethnicities, recent fever (AOR: 1.68, 95% CI: 1.08, 2.59), ln C-reactive protein (mg/L) (AOR: 1.23, 95% CI: 1.03, 1.45), and glucose-6-phosphate dehydrogenase defciency (AOR: 2.84, 95% CI: 1.88, 4.30) were associated with increased odds of anemia. Conclusion: Both nonmodifable and potentially modifable factors were associated with anemia. Thus some but not all anemia might be addressed through effective public health policy, programs, and delivery of nutrition and infection prevention and control. J Nutr 2020;150:929–937. Keywords: anemia, micronutrient status, child nutrition, Nepal, iron defciency, vitamin A defciency, infection Introduction Worldwide, anemia affects an estimated 43% of children aged <5 y (1) and is thought to contribute to an esti- mated 591,000 perinatal deaths annually (2). Globally, iron defciency is estimated to cause half of anemias; however, the proportion likely varies by population (2). Beyond iron defciency, numerous other factors contribute to anemia includ- ing problems producing hemoglobin (infammation-induced iron sequestration, thalassemias), lack of suffcient DNA precursors (folate and vitamin B-12 defciencies), erythrocyte damage and hemolysis [parasitic infections, blood disorders such as glucose-6-phosphate dehydrogenase defciency (G6PD), immune-mediated destruction], and blood loss (Figure 1). Published by Oxford University Press on behalf of the American Society for Nutrition 2019. This work is written by (a) US Government employee(s) and is in the public domain in the US. Manuscript received April 3, 2019. Initial review completed May 23, 2019. Revision accepted November 22, 2019. First published online December 28, 2019; doi: https://doi.org/10.1093/jn/nxz307. 929 Downloaded from https://academic.oup.com/jn/article/150/4/929/5688756 by guest on 24 June 2022