(P14-033-20) Anemia and Micronutrient Deficiencies in Young Children in Urban Slums of Mumbai, India

Objectives: To examine the burden of anemia and micronutrient deficiencies among young children living in urban slums of Mumbai, India.

Methods: Participants were children 10-18 months of age (n=278) residing in urban slums in Mumbai who were screened as part of a randomized feeding trial of biofortified pearl millet. Venous blood was collected by a pediatric phlebotomist and hemoglobin (Hb) concentrations were assessed via Coulter counter. Samples were processed and stored < −80°C until laboratory analyses. Serum ferritin (SF), vitamin B₁₂ , and erythrocyte (RBC) folate concentrations were analyzed via chemiluminescence. C-reactive protein (CRP) was analyzed by nephelometry, α-1 acid glycoprotein (AGP) was analyzed by spectrophotometry, and serum retinol was evaluated via HP-LC. Serum ferritin and serum retinol levels were adjusted for inflammation using methods proposed by Thurman. Anemia and severe anemia were defined as Hb< 11.0 g/dL and Hb< 7.0 g/dL. Iron deficiency (ID) was defined as SF< 12.0 µg/L,iron insufficiency was defined as SF< 20.0µg/L, and inflammation was defined as CRP >5.0 mg/L. Iron deficiency anemia was defined as Hb< 11.0 g/dL and SF< 12.0 µg/L. Vitamin A deficiency was defined as serum retinol < 20.0 µg/L. Vitamin B₁₂ deficiency and vitamin B₁₂ insufficiency were defined as < 148.0 pmol/L and < 221.0 pmol/L; folate deficiency was defined as RBC folate< 340 nmol/L. Linear and binomial regression models were used to examine associations of micronutrient biomarkers with Hb levels and risk of anemia.

Results: A total of 75.5% of children were anemic and 2.9% had severe anemia. The prevalence of iron deficiency was 61.4% (69.5% after Thurman adjustment), 57.4% of children had IDA, and 9.7% had CRP >5.0 mg/L. The prevalence of vitamin B₁₂ deficiency was 17.0%, 41.8% of children had vitamin B₁₂ insufficiency, and 19.9% had folate deficiency. Among anemic children, 84.5% had ≥1 micronutrient deficiency and 22.7% had ≥2 micronutrient deficiencies. Iron deficiency (RR: 2.15; 95% CI: 1.55, 2.99; p< 0.001), and vitamin B₁₂ deficiency (RR: 1.32; 95% CI: 1.09, 1.60; p< 0.01) were associated with significantly increased risk of anemia.

Conclusions: Findings indicate that the burden of anemia, iron deficiency, and vitamin B₁₂ insufficiency were high in young children in Mumbai, India.

Funding Sources: Harvest Plus; AF was supported by the National Institutes of Health.