| BACKGROUNDIron deficiency anemia (IDA) is an anemia which is characterized by reduced hemoglobin synthesis due to the iron deficiency, microcytic hypochromic anemia, decreased the level of serum ferritin and effective iron treatment. Iron deficiency(ID) including iron depletion (ID) that is caused by storage iron reduction in the initial stage, followed by iron-deficiency erythropoiesis (IDE), and eventually iron deficiency anemia (IDA).IDA is an important global public nutritional problems that is widespread in the world, especially in the developping countries. World Health Organization (WHO) pointed out that there were about4to5billion people worldwide (accounting for66%to80%of the world’s population) in the state of iron deficiency in2001, of which90percent are living in developping countries, especially in children, women of childbearing age and the elderly.International Nutrition Anemia Advisory Group pointed out that the prevalence of children anemia was66%in the Southeast Asian region in the2003, the African children anemia was60%, North American children anemia was7%. In2007, a retrospective study conducted by WHO shows that47.0%of preschool children were anemia in the world.Nutrition survey shows that China has undertaken in recent years, the IDA is a serious health problem among preschool children in China. The large-scale epidemiological survey from2000to2001, showed that among infants and young children the prevalence rates of IDA were20.5%,7.8%, respectively. North four City survey showed that the prevalence were Beijing1.40%, Shenyang2.14%, Dandong1.89%. Xingtai2.13%among2to7years old children in2001;The average prevalence rate of infants was4.8%in Futian District of Shenzhen in2003. The average prevalence rate among1to6years old children was2.27%in Hongkou District of Shanghai in2004. The average prevalence rate was6.65%among3to7-year-old children in Pulandian City, Liaoning Province in2009. The average prevalence rate was20.2%among6months to3-year-old infants in Bole City, Xinjiang Province in2011. So far, there has not been statistical data about epidemiological investigations of IDA among infants and related studies in Zhongshan City.People have pay more attention on the impact of non-hematopoietic system, a research has confirmed the children who suffering from IDA have many problems.such as fine motor retardation, mental retardation, auditory brainstem response changes, understanding loss, observation backward, poor learning ability, cognitive poor, and higher susceptibility to lead poisoning. The prospective studies conducted by Foreign scholars have confirmed that in the the damage to the behavioral and psychological development and growth were sustainable for more than10years after treatment for the infants and children with chronic, severe IDA, and even irreversible damage. Domestic tracking survey conducted by Jingjin found that the fine motor development in early childhood is still lower than the children without anemia in similar social background after the IDA has been effectively corrected, and the long-term impact of brain damage was a significant linear relationship with the continuing and severity of IDA.Therefore, the prevention of IDA is still the focus of the common childhood diseases.However, unlike other nutrients, the body can not excrete the excessive iron, the survey showed the excess supply of iron are likely to have a negative impact on the growth and development, the malaria infection, and even cognitive development. The new evidence supported that the IQ tests in the infants fed fortified iron formula is11points lower on average than the infants fed low-iron formula when they are10years old. therefore, the iron supply should be avoided for the lower prevalence population. There is an urgent need to acquire the prevalence of IDA among infants in our city, in order to guide the prevention.The dietary survey for high-prevalence areas of IDA in recent years, suggest that the dietary iron intake is not low, and some even up to the Adequate Intake (Adequate intake, AI)200%. Unreasonable dietary structure, poor eating behavior, food processing, cooking and other factors may be the main reasons of high incidence in the case of sufficient iron intake.Early childhood is a critical period of growth and molding personality, and also is the optimal period of shapping habits. Early dietary behavior has a profound impact on the health in the whole life. Good eating habits is a guarantee of the various nutrients intake in the food. The eating behavior include four parts about feeding behavior, eating behavior, food choices and eating atmosphere.The problems of eating behavior occur at all ages, especially2to6years old children. According to parental report, the incidence can be as high as60%, but professional report about25%to30%.OBJECTIVE1.To carry out the epidemiological study of IDA among1-3-year-old children in Zhongshan City, we can acquire the prevalence of IDA among infants in this region, and compare the differences between the both different age group and the different gender groups. the aim is to provide the basic data for the prevention work.2.Establishment the network management software system of iron deficiency anemia,so that the treatment and track management of IDA through the network of information technology to make the prevention standardized,systematic and individualized.3.Through the questionnaire, to explore the risk factors in terms of eating behaviors that may exist among1-3-year-old of IDA children in Zhongshan City, to provide scientific guidance for prevention.4.Popularizing the knowledge of IDA to develop a reasonable diet structure, especially for the main feeding of infants in the family, preschool, to correct their poor eating behavior, and to avoid the risk factors;METHODS1. To determine the sample sizeA large-scale epidemiological investigations, conducted by Collaborative group of Chinese children iron deficiency, suggested the average prevalence of IDA is7.8%among infants in our country in2000to2001, to estimate the sample size by the formula, the allowable error2%,extracted690cases as the subjects who are1-3-year-old, They are divided into two groups.12-24-month-old group(A group,n=345),25-36-month-old group(B group,n=345).The boys and girls are nearly half in each group.Sample size have been evenly distributed within the span of this age group.2. Setting the inclusion criteria of study object①Examination without chronic bleeding;②draw off blood without the digestive and respiratory infections;③Not taking iron before3months when draw off blood.3. To randomly select subjects by a simple random sampleAccording to the inclusion criteria,randomly select690cases who are1-3-year-old,examined in the Child Health Division of our hospital from September1,2010to March31,2011, to survey the prevalence of IDA.Reference to the diagnostic criteria developed by the Editorial Board of Pediatrics in2008.①Have clear causes of iron deficiency:such as the insufficient supply of iron, malabsorption, increased demand, or chronic blood loss;②Hemoglobin (HGB)<110g/L;③erythrocytes were microcytic hypochromic:mean corpuscular volume (MCV)<80fl, mean corpuscular hemoglobin (MCH)<27pg, mean corpuscular hemoglobin concentration (MCHC)<310g/L;④Abnormal iron metabolism indicators:serum ferritin(SF)lower (<15ug/L), and rule out the influence of inflammation of its impact;The one suffered microcytic hypochromic anemia who meet the items2,3, in iagnostic criteria, as well as combined with a clear etiology of iron deficiency that can be diagnosed as IDA, if iron metabolism indicators meet the items4, in the same time, it can be diagnosed as the IDA.4. Questionnaire was used to understand the prevalence rate of IDA in the regionThe children who are diagnosed as IDA as the case group, and select children as the control group, of whose age the difference is not more than three months, and Hb>110g/L, at the same period in our hospital. According to the1:1principle, to analyze the risk factors through questionnaires. The questionnaire includefour parts, such as feeding environment (3variables), child eating behavior,(4variables), and feeding behavior of (3variables), the general of the family (three variables). We take the13possible risk factors as the variables to analysis.5.Data processing and statistical analysisEstablish a database with the Excel spreadsheet, and process with the SPSS13.0statistical package, a four-cell table χ2test to compare the differences in prevalence rates between12-24-month-old group and25-36-month-old group,and between the boys and girls in the same month group. Compare the differences of the overall distribution in the each single factor of eating behaviors with the2-independent samples Wilcoxon rank sum test between the IDA group and non-IDA group. Study the statistics association between the eating behavior variables and IDA with Logistic regression analysis.select the inspection levela=0.05.RESULTS1.The prevalence rate of IDA among1-3-year-old children in Zhongshan CityThe sample survey suggest the average prevalence rate of IDA for690cases is7.0%in Zhongshan City. The highest prevalence rate of IDA in the12-24months group is9.7%, and the25-36months group is4.3%, the difference of the prevalence between the both groups is statistically significant(x2=7.486, P=0.006), the prevalence is related to the age of children, and the prevalence is lower with the age increasing. The prevalence rate of IDA for boys and girls is7.5%and6.5%respectively. The difference of the prevalence between the different gender groups is not statistically significant (12-24-mo-old children χ2=0.157, P=0.692,25-36-mo-old children χ2=0.305, P=0.581).2.The comparison for eating behavior factors between IDA group and non-IDA groupFeeding environment The overall distribution of the usage of the Special cutlery between the IDA group and non-IDA group are the same location (Z=-0.030.P=0.976). The overall distribution of the Situation of the fixed dining place between the two groups are the same location (Z=-0.029, P=0.977). IDA group and non-IDA group in the variable of having a pleasant atmosphere have the same overall distribution (Z=-1.715, P=0.086).Eatting behaviors The survey shows that the degree of picky eaters in the IDA group is significantly higher than the non-IDA group(Z=-4.483,P=0.000). Among the IDA children, the daily diet is mainly composition of carbohydrates, fruits and vegetables and other plant foods, and they do not like to eat non-staple food such as liver, soy, beef.the frequency of the risk factor which is eating for a long time take place in the IDA group is higher than the non-IDA group(Z=-3.397, P=0.001). The frequency of meals or pre-dinner snacking in IDA group is higher than the non-IDA group (Z=-5.091, P=0.000). The snacks types prefer to acidophilous milk, sweets, fruits, fried spicy food. A limited attention span for children, the proportion of watching TV, playing with toys, playing games, walking and eating, parents chasing at eating are larger. The overall distribution of the factor that infants cannot concentrate on the food between the two groups have the same location (Z=-0.835, P=0.404).Feeding behaviors The survey shows that there are the same position of the overall distribution for the emotional interaction between the IDA group and the non-IDA group(Z=-1.064, P=0.287). The overall distribution of independent eating opportunities between the two groups have the same location (Z=-0.057, P=0.955). The overall distribution of picky eaters among the parents between the two groups have the same location (Z=-1.671, P=0.095). The general condition in families The findings are the overall distribution for parents’education and monthly income between the IDA group and the non-IDA group have the same location (the education level of mother Z=-1.346, P=0.263; the education level of father Z=-0.919, P=0.265; the economic level of per capita Z=-0.578. P=0.563).3.Logistic regression analysis of eating behavior factors related to IDAThe factors of a long meal time significantly affect the prevalence of IDA [OR=3.415,95%CI(1.188,9.812)](P=0.023). The factors of picky eaters significantly affect the prevalence of IDA [OR=5.029,95%CI (2.070,12.217)](P=0.000) The bad behaviors, such as "too much to eat snacks between meals","to eat snacks before a meal" among the most young children, have a significantly influence in the prevalence of IDA.[OR=6.226,95%CI(2.096,18.492)](P=0.001).The factor of which the parents and children have emotional communication during the meals significantly affect the prevalence of IDA.[OR=6.722,95%CI(1.507,29.984)](P=0.013)CONCLUSIONS1.The prevalence rate of IDA is7.0%among1-3-year-old children in this city. The prevalence is significantly related to the age of infants. It shows that the prevalence is lower with the age increasing. The difference of the prevalence between the different gender groups is not statistically significant.2.The main reasons for the region’s children suffering with IDA including the picky habits, too long meal time, not be interested in food, and meals or pre-dinner snacking too much are significantly correlated the IDA. Formulating the reasonable guidance of eating behaviors can play a role in improving anemia.3.The parents lack parenting knowledge, which is the social factors of IDA, including the higher educational level of parents. Strengthening the public health education is imperative. |
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