Effectiveness of zinc protoporphyrin/heme ratio for screening iron deficiency in preschool-aged children

Hemoglobin and zinc protoporphyrin (ZPP) tests are commonly used to screen for iron deficiency, but little research has been done to systematically evaluate the sensitivity and specificity of these two tests. The goal of this study was to evaluate the effectiveness of zinc protoporphyrin/heme (ZPP/H) ratio as a point-of-service screening test for iron deficiency among preschool-aged children by comparing the sensitivity and specificity of hemoglobin, ZPP/H ratio, and serum ferritin (SF). Also completed were assessments for the prevalence of anemia, iron deficiency (ID), and iron deficiency anemia (IDA) with indicators of ferritin models. This study was carried out with 95 children ages 3 to 6 y. Anthropometric measurements were assessed, and blood samples were analyzed for hemoglobin, SF, transferrin saturation (TS), and ZPP. Anemia was common and the prevalences of anemia, ID, and IDA were 14.7%, 12.6%, and 5.2%, respectively. The ZPP/H ratio was strongly and significantly correlated with hemoglobin. And ZPP/H ratio was a more sensitive test for ID than hemoglobin or SF measurement, correctly identifying more than twice as many iron-deficient children (sensitivity of 91.7%, compared to 41.7% for hemoglobin and SF). However, ZPP/H ratio had lower specificity (60.2%, compared to 89.1% for hemoglobin or 96.4% for SF) and resulted in the false identification of more subjects who actually were not iron deficient than did hemoglobin or SF. Low hemoglobin concentration is a late-stage indicator of ID, but ZPP/H ratio can detect ID at early stages and can be performed easily at a relatively low cost. Therefore, ZPP/H ratio can serve as a potential screening test for pre-anemic iron deficiency in community pediatric practices.

A Study on the Dietary Behaviors, Physical Development and Nutrient Intakes in Preschool Children

The purpose of this study was to investigate the health status of preschool children using the questionnaires about dietary behaviors and anthropometric indices. And also nutritional status was investigated using questionnaires for 24-hr recall method. The study was conducted in 145 children aged 3 to 6 years and questionnaires for dietary behaviors and dietary intakes were performed by mothers of children in Ulsan. Just nine percent of children were graded as good in terms of having healthy eating habits, this means that the nutrition education for the dietary behaviors should be more focused on preschool children. With regard to the frequency of food intake, children consumed green & yellow vegetables less frequently, meanwhile consumed high protein source food (meat, egg and bean) and milk and its product more frequently. Children almost never consumed fried foods as often as 1-2 times a weak. In assessment of the health status, children have the highest prevalence of colds and allergy, but lower prevalence of clinical symptoms due to the nutritional deficiency. The mean height was 103.6 +/- 6.4 cm and significantly different among age (p < 0.05), but was not significantly different between sex. The mean weight was 17.8 +/- 3.0 kg and significantly different in 5, 6years old among age. By the WLI criteria, 11.1% of children were underweight and 17.4% of children were overweight or obese. By the Rohrer index criteria, any children were not underweight and 86.8% of children were overweight or obese. By the Kaup index criteria, 2.8% of children were underweight and 29.2% of children were overweight or obese. And Obesity Index criteria, 2.1% of children were underweight and 20.8% of children were overweight or obese. The results of obesity rate by all criteria except Rohrer index indicated similar level, were significantly high in age 3 with all criteria, and decreased with age increased. The energy intake of children was lower than EER (Estimated Energy Requirements) of Dietary Reference Intakes for Koreans (KDRIs) by as much as 85.7%. Acceptable Macronutrient Distribution Ranges (AMDR) was 62.6:21.5:15.7 as carbohydrate:protein:lipid, so children consumed protein more, but consumed lipid less compared with those of KDRIs. Vitamin A intake was 133% of recommended intakes (RI) and calcium intake which was identified as the nutrient most likely to be lacking in diets was 98.9% of RI. The intakes of all minerals and vitamins except folate were higher than KDRIs. 33.3% of children were distributed in insufficiency of energy intake, 42.7% of children were distributed in insufficiency of lipid intake. These results indicate that the need of developing of nutrition education program and further concern of a public health center, university and children care center about dietary life for preschool children.

Nutrient Intakes Differences of the People Living Near the Nuclear Plant by the Household Income Level / 대한지역사회영양학회지

This study was conducted to measure and evaluate the food and nutrient intakes of the people living near the nuclear plant and to investigate the relationship between the household income level and the food and nutrient intake patterns. A total of 552 cases (263 males and 289 females) were surveyed during the period from April 1 to December 21 of 2005. Dietary intake was measured by means of the 24-hour recall method. The data were analyzed using SPSS Windows (ver. 14.0). The household income level of the subjects was classified into two groups : Low income group (LIG; 2,000,000). The subjects at large had less energy and nutrient intakes than did the population in town and village who participated in the 2005 National Health and Nutrition Survey. The intake of calcium, zinc, vitamin A, riboflavin, vitamin B6, vitamin C, and folic acid was less than the Estimated Average Requirement in case of 50~95% of the subjects. The LIG consumed less beans, vegetables, fruits, meats, and beverages than did the HIG in male, while the LIG consumed less eggs and beverages than did the HIG in female. The LIG consumed less nutrients than did the HIG in male, except for carbohydrate, while the LIG consumed less nutrients including zinc, vitamin A, riboflavin, vitamin B6, vitamin C, folic acid than did the HIG in female. In addition, the LIG had higher percentage energy consumption from carbohydrate. These results suggest that higher food and nutrient intake is associated with higher income.

A Study on the Nutrient Intakes and Zinc Nutritional Status of Preschool Children in Ulsan

The purpose of this study was to determine the zinc status of preschool children in Ulsan. The study was conducted in 95 children aged 3 to 6 years by investigating the anthropometric indices and assessing the biochemical analysis. The blood was analysed to assess serum zinc and alkaline phosphatase. And a questionnaire for dietary intakes using 24-hr recall method were performed by mothers of 95 subjects. The dietary intakes of children were analysed to determine the prevalence of inadequate and excessive intakes of zinc with Dietary Reference Intakes for Koreans (KDRIs). WHL (Weight-Length Index) and Kaup index were used to define obesity. The overall prevalence of overweight and obese subjects were 14.7% and 6.3% by WHL, were 15.8% and 13.7% by Kaup index. The mean intakes of zinc by children aged 3~5y and 6y were 5.5 +/- 1.4 mg/d (75.7% RDA) and 6.7 +/- 2.0 mg/d, respectively, that was the level exceeding the estimated average requirement (EAR) and the recommended intake (RI) of Korean Dietary Reference Intakes. Less than 1.3% and 7.9% of children had usual zinc intakes below EAR and RI of KDRIs, respectively. The percentages of children with intakes exceeding the tolerable upper intake level (UL) were 2.6%. The zinc nutritional status by biological assay was found that mean serum zinc and alkaline phosphatase (ALP) of total subjects were 64.0 +/- 8.4 microgram/dl and 72.8 +/- 14.9 U/L, there was not a significant difference between boys and girls. The range of serum zinc level was 45~89 microgram/dl and children with a low serum zinc concentration by several cut-off points were 18.9~55.8%, especially. Serum zinc level was positively correlated to the intakes of calorie, calcium, fiber, iron, zinc, zinc/kg and height (p < 0.001). Serum ALP was positively correlated height, weight and WLI. The zinc intake of children also showed a positive correlation with height and weight. These results indicate that there were significant correlations between the zinc status and growth of preschool children. Preschool children in Ulsan have dietary zinc intakes that exceed the new DRIs. The present level of intake does not seem to pose a health problem, but if zinc intakes with fortified foods and supplements were considered, the amount of zinc consumed by children may become excessive.

A Study on the Iron Nutritional Status with Biochemical Parameters in Preschool Children

The purpose of this study was to determine the iron status of preschool children in Ulsan, Korea. The study was conducted using 95 children aged 3 to 6 years by investigating the anthropometric indices and assessing the dietary intakes and biochemical analysis. A questionnaire for dietary intakes using 24-hr recall method were carried out by the mothers of the 95 subjects. And also a study was conducted to assess hematological and biochemical status of iron and prevalence of iron deficiency. The average height and weight were 105.4 +/- 7.0 cm, 18.7 +/- 3.2 kg in boys, 103.8 +/- 6.7 cm, 17.6 +/- 2.7 kg in girls. These were lower than the body growth standard values of Korean pediatrics. There was not a significant difference in both between boys and girls. For the daily nutrient intake, energy was 1201.5 +/- 280.9 kcal (79.3%RDA), protein was 63.8 +/- 28.2 g (219.4%RDA), iron was 11.9 +/- 4.5 mg (133.2%RDA). The iron nutritional status by hematological assay found that Hct was 34.7 +/- 2.0 (%), Hb was 12.0 +/- 0.8 g/dl, RBC was 4.3 +/- 0.3 (106/microliter), MCV was 80.5 +/- 3.0 fL, MCH was 27.8 +/- 1.1 pg and MCHC was 34.6 +/- 0.6 g/dl. The biochemical measurement of serum iron was 75.6 +/- 30.3 microgram/dl, TIBC was 320.3 +/- 34.1 microgram/dl, serum ferritin was 30.0 +/- 14.8 microgram/L, Zinc-protophorphyrin (ZPP) was 32.7 +/- 8.0 microgram/dl, and ZPP/Heme was 71.1 +/- 19.5 (micromole/mol heme). The prevalence with Hct, Hb, TS and serum ferritin less than cut-off value was 8.4%, 9.5%, 12.6% and 4.4% respectively. But the prevalence of iron deficiency estimated with ZPP and ZPP/Heme criteria were 25.3% and 27.4%, and were higher than in case of any other indices. The prevalence of iron deficiency anemia ((low Hb (< 11.0 g/dl) and low serum ferritin (< 10 microgram/L) or low TS (3 - 4 years: < 12%, 5 - 6 years: < 14%))was found in only one 3 year old girl. The prevalence of iron deficiency except Hct and Hb was the highest in 3 year group, but the prevalence by Hct and Hb was the highest in 5 year group. Iron deficiency and iron deficiency anemia do not seem to be a major public health problem in preschool children in Ulsan.