Correction: Effect of Providing Multiple Micronutrients in Powder through Primary Healthcare on Anemia in Young Brazilian Children: A Multicentre Pragmatic Controlled Trial.

[This corrects the article DOI: 10.1371/journal.pone.0151097.].

Effect of Providing Multiple Micronutrients in Powder through Primary Healthcare on Anemia in Young Brazilian Children: A Multicentre Pragmatic Controlled Trial.

BACKGROUND: Multiple micronutrients in powder (MNP) are recommended by WHO to prevent anemia in young children. However, evidences for its effectiveness in different populations and improvements in other outcomes (e.g. linear growth and vitamin A deficiency) are scarce. METHODS: A multicentre pragmatic controlled trial was carried out in primary health centres. At study baseline, a control group (CG) of children aged 10- to 14 months (n = 521) was recruited in the routine healthcare for assessing anemia, anthropometric and micronutrient status. At the same time, an intervention group (IG) of infants aged 6- to 8 months (n = 462) was recruited to receive MNP daily in complementary feeding over a period of 60 days. Both study groups were compared when the IG infants reached the age of the CG children at enrolment. RESULTS: In CG, the prevalence of anemia [hemoglobin (Hb) < 110 g/L], iron deficiency (ID, plasma ferritin < 12 µg/L or TfR > 8.3 mg/L), and vitamin A deficiency (VAD, serum retinol < 0.70µmol/L) were 23.1%, 37.4%, and 17.4%, respectively. Four to six months after enrolment, when the IG participants had the same age of the controls at the time of testing, the prevalence of anemia, ID and VAD in IG were 14.3%, 30.1% and 7.9%, respectively. Adjusting for city, health centre, maternal education, and age, IG children had a lower likelihood of anemia and VAD [Prevalence Ratio (95% CI) = 0.63 (0.45, 0.88) and 0.45 (0.29, 0.69), respectively] when compared with CG children. The adjusted mean distributions of Hb and length-for-age Z-scores improved by 2 SE in the IG compared to CG children. CONCLUSIONS: MNP effectively reduced anemia and improved growth and micronutrient status among young Brazilian children. TRIAL REGISTRATION: Registro Brasileiro de Ensaios Clinicos RBR-5ktv6b.

Risks of anemia in infants according to dietary iron density and weight gain rate.

BACKGROUND: The objective of the study was to identify risk factors of infant anemia and to assess a new indirect method to identify the risks of anemia using a probability curve based on dietary iron density and weight gain rate. METHODS: A cross-sectional study was conducted on 110 term infants in a public health unit in Goiania, Brazil. A socioeconomic, demographic, anthropometric survey and dietary assessment were performed. Hemoglobin, red blood cell distribution width (RDW), ferritin, and C-reactive protein were determined. RESULTS: The risk factors identified by final adjusted logistic regression were male infants (OR = 2.38), infants whose mothers were housewives (OR = 5.01), and households with more than three members (OR = 3.08). Another risk factor was the introduction of meat after 6 months (OR = 3.3). There was a positive dose-response effect between milk consumption and prevalence of anemia adjusted for sex and age (Effect = 0.120; 95% CI: 0.015, 0.225). Dietary iron density (from 6 to 9 months) and weight gain rate (from 9 to 12 months) significantly affected the probability of the infant having anemia. CONCLUSIONS: The probability curve for anemia obtained from dietary iron density and weight gain rate can be used to identify the risks of anemia, and together with the risk factors identified are important for anemia prevention programs.

Anemia do lactente: etiologia e prevalência / Anemia in infancy: etiology and prevalence

Objetivos: verificar a prevalênciade anemia, anemia ferropriva e deficiência de ferro em lactentes, de unidade pública de saúde, no município de Goiânia, Brasil, analisar e correlacionar as variáveis bioquímicas e hematológicas.Métodos: realizou-se estudo transversal. De 120 mães entrevistadas, foram incluídos 1101actentesde6a 12 meses de idade, a termo e não gemelares. Dados socioeconômicos e hematológicos foram obtidos. Colheu-se sangue venoso dos lactentes em jejum para realização do hemograma completo por contagem eletrônica, ferrosérico, ferritinaséricae proteína C-reativa, os quais foram utilizados na avaliação da etiologia ferropriva nos anêmicos. Crianças com hemoglobina < llg/dl foram consideradas anêmicas.Resultados: a prevalência de anemia observada foi de 60,9por cento.Ao se considerar no diagnóstico da etiologia ferropriva nos lactentes sem processo inflamatório, a alteração da hemoglobina mais dois índices entre volume corpuscular médio (VCM), ou hemoglobina corpuscular média (HCM), ou ferritina, ou ferro sérico, a prevalência de etiologia ferropriva foi de 87por cento. Porém, ao se incluir nos índices a amplitude de distribuição dos eritrócitos (RDW), a prevalência foi de 97,8por cento. Nos não anêmicos, considerando a ferritina e o RDW, observou-se 28por cento de prevalência de deficiência de ferro. As melhores correlações entre as variáveis hematológicas e bioquímicas foram hemoglobina e hematócrito (r = 0,946), e HCM com o VCM (r = 0,950).Conclusão: a principal etiologia da anemia nos lactentes foi a ferropriva, cuja prevalência variou com os diferentes parâmetros utilizados e critérios adotados

[Anemia in infancy: etiology and prevalence]. / Anemia do lactente: etiologia e prevalência.

OBJECTIVE: To verify the prevalence of anemia, iron deficiency anemia and iron deficiency in infants, at a Public Health Unit in the city of Goiânia-Brazil; to analyze and to correlate the hematologic and biochemical variables. METHODS: A cross-sectional study was carried out. One hundred and ten full-term infants of the 120 mothers interviewed were included. The infants aged between six and twelve months and there were not twins. Socioeconomic and hematologic data was obtained. Venous blood was taken from fasting infants in order to carry out a complete hemogram through electronic cell counting, serum iron, serum ferritin and C-reactive protein, which were used in the evaluation of the etiology of iron deficiency in the anemic infants. Children with hemoglobin <11 g/dL were considered anemic. RESULTS: The prevalence of anemia was 60.9%. In the diagnosis of the iron deficiency etiology in infants without an inflammation process, when considering the alteration of hemoglobin plus two more indices among mean corpuscular volume (MCV) or mean corpuscular hemoglobin (MCH) or serum ferritin or serum iron, the prevalence of the iron deficiency was 87%. Nevertheless, when red cell distribution width (RDW) was included in the indices, the prevalence was 97.8%. In the non-anemic infants, considering ferritin and RDW, the prevalence of iron deficiency observed was 28%. The best correlation among hematologic and biochemical variables were between hemoglobin and hematocrit (r=0.946), and MCH with MCV (r=0.950). CONCLUSIONS: The main etiology in infants was iron deficiency anemia and its prevalence varied according to different parameters and criteria.