Topics in Minority Health
High Prevalence of Iron Deficiency Anemia
Among Alaskan Native Children
Iron deficiency anemia has long been recognized as a common
nutritional problem among Alaskan Native children (1-3). Even
though
the prevalence of childhood iron deficiency anemia in the United
States as a whole has declined in the past decade (4), data from
several sources show that the prevalence of anemia remains high
among
Alaskan Native children. These sources include 1) the database of
the
Alaska Area Native Health Service for children aged 5-72 months,
2) a
survey of Yupik Eskimo schoolchildren (aged 6-17 years) in 15
villages
in the Yukon-Kuskokwim Delta (YKD) region in 1986-1987, and 3) a
1987
survey of 318 schoolchildren in seven villages in the Bristol Bay
region.
The computerized medical-record database for the Alaska Area
Native Health Service includes hemoglobin and hematocrit values
for
1983-1985 for children aged 5-72 months who were eligible for
care.
Testing is recommended as part of routine well-baby care at ages
6,
10, and 18 months and before the child enters school. In the years
1983-1985, more than 4,000 test results were recorded annually,
and
the prevalence of anemia (hemoglobinless than 11 g/dL,
hematocritless
than 34%) ranged from 22% to 28% in children under 5 years of age.
The two regional surveys focused on determining hemoglobin
values
in school- aged children (Table 1). A total of 876 children were
tested in the 15 YKD villages, and 318 in the seven Bristol Bay
villages. Overall, the combined prevalence of anemia for the
Bristol
Bay area was 23% and for the YKD area, 10%. Serum ferritin levels
were
also determined on a random sample of 83 children in YKD; 65% had
a
value below 10 ng/dL, the diagnostic cutoff value for iron
deficiency.
Reported by: M Thiele, RD, MPH, Yukon-Kuskokwim Health
Corporation,
Bethel; ME Geddes, RD, MS, Bristol Bay Area Health Corp,
Dillingham; E
Nobmann, RD, MPH, K Petersen, MD, Alaska Area Native Health Svc,
Indian Health Svc, Anchorage, Alaska. Arctic Investigations
Laboratory, Center for Infectious Disease, Anchorage, Alaska; Div
of
Nutrition, Center for Health Promotion and Education, CDC.
Editorial Note: Based on three sources of data, the prevalence
of
anemia among Alaskan Native children was higher than 20% for
children
under 5 years old and was 10% or greater overall for older
children
and adolescents. By comparison, data from the second National
Health
and Nutrition Examination Survey of 1976-1980, which used similar
criteria for anemia, show that the prevalence of anemia in the
entire
United States was 4% for children 3-5 years old, 3% for children
6-11
years old, 3% for males 12-17 years old, and 5% for females 12-17
years old (5). Also, the recently reported decline in prevalence
of
anemia among U.S. children from low-income families may mean that
the
current prevalence of anemia in the United States is even lower
(4).
Comparing the findings of the current Bristol Bay survey with
those of
a detailed study done in the same region in 1975 shows no evidence
of
improvement in the prevalence of anemia (6).
The 1975 Bristol Bay survey documented that most of the anemic
children had a significant rise in hemoglobin after oral iron
treatment; this improvement indicates that iron deficiency was the
primary cause of anemia. The high percentage of children who had
low
ferritin levels observed in the recent study in the YKD also
confirms
that anemia is mainly related to iron deficiency. The cause of the
iron deficiency among Alaskan Native children, especially the
older
children, is not clear. In other U.S. populations, most cases of
anemia occur in younger children, whose iron deficiency results
from
inadequate iron intake in infancy, and the prevalence declines by
preschool age (7). The traditional Native Alaskan diet generally
contains many iron-rich items such as meat and fish. However, a
recent
study of diets of children in the Bristol Bay area found common
consumption of non-native food that is relatively low in iron
content
(Alaska Area Native Health Service, Public Health Service,
unpublished
data). It remains to be determined whether this lower intake of
iron
alone can explain the lower hemoglobin values, or whether iron
metabolism is affected by other dietary factors such as inhibitors
of
iron absorption.
References
Scott EM, Wright RC, Hannan BT. Anemia in Alaskan Eskimos. J
Nutr
1955;55:137-49.
Petersen KM, Brant LJ. Growth and hematological changes in the
Eskimo children of Wainwright, Alaska: 1968 to 1977. Am J Clin
Nutr 1984;39:460-5.
Burks JM, Siimes MA, Mentzer WC, Dallman PR. Iron deficiency
in an
Eskimo village: the value of serum ferritin in assessing iron
nutrition before and after a three-month period of iron
supplementation. J Pediatr 1976:88:224-8.
Yip R, Binkin NJ, Fleshood L, Trowbridge FL. Declining
prevalence
of anemia among low-income children in the United States. JAMA
1987;258:1619-23.
Dallman PR, Yip R, Johnson C. Prevalence and causes of anemia
in
the United States, 1976 to 1980. Am J Clin Nutr
1984;39:437-45.
Margolis HS, Hardison HH, Bender TR, Dallman PR. Iron
deficiency
in children: the relationship between pretreatment laboratory
tests and subsequent hemoglobin response to iron therapy. Am J
Clin Nutr 1981;34:2158-68.
Dallman PR, Siimes MA, Stekel A. Iron deficiency in infancy
and
childhood. Am J Clin Nutr 1980;33:86-118.
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