Nutritional anemia in preschool children

240 Pages·2017·3.31 MB·English

by  Gupta

Anil Gupta
Nutritional
Anemia in
Preschool
Children
Nutritional Anemia in Preschool Children
Anil Gupta
Nutritional Anemia
in Preschool Children
Anil Gupta
Department of Physiology and Biochemistry
Eklavya Dental College and Hospital
Kotputli, Rajasthan, India
ISBN 978-981-10-5177-7 ISBN 978-981-10-5178-4 (eBook)
DOI 10.1007/978-981-10-5178-4
Library of Congress Control Number: 2017945829
© Springer Nature Singapore Pte Ltd. 2017
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microfilms or in any other physical way, and transmission or information
storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology
now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, express or implied, with respect to the material contained herein or for any errors
or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims
in published maps and institutional affiliations.
Printed on acid-free paper
This Springer imprint is published by Springer Nature
The registered company is Springer Nature Singapore Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721,
Singapore
With humility and sincerity, I dedicate this
book to the memory of my younger brother,
the late Shri Sudhir Gupta, who struggled for
life and left for heavenly abode for eternal
peace.
Preface
Nutritional anemia is a major public health hazard with global prevalence affecting
children in preschool age and women during pregnancy and lactation. Population in
rural areas, slums and remote settings have higher predisposition to deficiency of
iron, folic acid and macronutrients and infection owing to illiteracy, poverty, limited
access to medical facility, poor hygiene, improper sanitation and lack of motivation.
In a report by WHO in 1980, it was estimated that about 700 million population,
globally, suffered from anemia. Moreover, around 50 % of the anemia prevalence
was attributed to iron deficiency. However, the prevalence of nutritional anemia is
variable all over the world due to wide variations in dietary pattern, literacy rate,
socioeconomic status, medical facility and environmental conditions. Developing
countries have higher vulnerability towards anemia. Millennium Development
Goals were laid against worldwide poverty and hunger, HIV infection, malaria and
child mortality and in favour to achieve gender equality, universal primary educa-
tion and environmental sustainability.
Despite the large accomplishments pertaining to worldwide targets set forth,
however, a big proportion of the population in distant regions and the proportion
who suffered discrimination owing to gender disparity, geographical location and
ethnicity have still to be benefitted. Achievements have been skewed throughout the
world. According to the Millennium Development Goals report of 2015, about 800
million population today survive in utmost poverty and severe inadequacy of food.
Around 160 million children below the age of 5 years suffer from stunted growth
due to insufficient food intake. Diarrhoea and malaria in children under 5 years
inflict a high disease burden responsible for high child mortality and morbidity.
Still, another 2.4 billion population do not have access to proper sanitation, and a
large segment of population still defecates in the open. The developing world har-
bours around 880 million population living in highly pitiable state in slum areas.
A huge population is struggling for survival on the thinnest and unpalatable
sources of food per day in the deserted and isolated areas, where it must face extreme
hot and cold weather. This section of human community is living in highly deplor-
able conditions without even knowing the Millennium Development Goals set forth
for its betterment.
vii
viii Preface
I feel immense pleasure and exhilaration on the completion of the book
Nutritional Anemia in Preschool Children. Submissively, I would admit that exten-
sive and intensive approaches have been practised for writing the book. It is designed
to furnish valuable minute details relevant to the topic. It incorporates a concise text
on the introduction and epidemiology of nutritional anemia in preschool children.
Dietary iron deficiency is inflicting the poverty-stricken population in developing
countries. An exhaustive information has been provided over the role of iron in the
body, iron metabolism and the aetiology of iron deficiency anemia in children.
Implications of geophagy, Plasmodium falciparum infection and HIV infection
have been broadly discussed pertaining to their involvement in the pathogenesis of
anemia.
Chapters focusing on laboratory methods for the screening of haemoglobin; role
of vitamin B and folic acid, copper, zinc and selenium; and impact of vitamin A
12
illustrate fine details of the subject. Remote predisposing factors such as diarrhoea,
malnutrition and the effect of cow milk on the occurrence of anemia in children
have been incorporated in the book.
The present book is the result of my knowledge gained through postdoctoral
research on the nutritional status of children between 2 years and under 5 years of
age. I hope the book will be helpful in the dissemination of facts, ideas, concepts
and knowledge among academicians, research scholars and students. Efforts are
taken to provide an error-free book; however, I welcome any criticism, comment or
suggestion for the improvement of the forthcoming edition of the book.
Kotputli, Rajasthan, India Anil Gupta
15 August 2016
Acknowledgements
Almighty Shri Shirdi Sai Baba bestowed upon me knowledge and perseverance for
writing the book. My father, Shri Ved Parkash Gupta, always inspires me for high
endeavour. I am highly indebted to my father for instilling the habit of learning in
me, since my school days.
Throughout the period of writing, I had encountered a number of obstacles.
However, my wife has been a source of motivation to me to come out successfully
through thick and thin.
Further, I owe my gratitude to Dr. Abhinav Shreshtha, associate editor of bio-
medicine at Springer (India) Pvt. Ltd., for his support, cooperation and gentle atti-
tude which helped me a lot in the completion of the book.
ix
Contents
1 Introduction ............................................................................................. 1
1.1 Definition........................................................................................ 1
1.2 Overview ........................................................................................ 2
References ................................................................................................. 4
2 Epidemiology of Nutritional Anemia .................................................... 7
2.1 Global Prevalence........................................................................... 7
2.2 Prevalence of Nutritional Anemia in India ..................................... 8
References ................................................................................................. 9
3 Physiological Contemplation of Iron in the Body ................................ 11
3.1 Overview ........................................................................................ 11
3.2 Average Iron Content in the Human Body ..................................... 12
3.2.1 Infancy .............................................................................. 12
3.2.2 Childhood ......................................................................... 14
3.2.3 Adolescence ..................................................................... 14
3.2.4 Females in Reproductive Age Group ............................... 15
3.2.5 Adult Males and Postmenopausal Females ...................... 15
3.3 Daily Iron Requirement.................................................................. 15
3.4 Essential and Functional Iron Compounds .................................... 16
3.4.1 Haemoglobin and Myoglobin .......................................... 16
3.4.2 Catalases ........................................................................... 17
3.4.3 P eroxidases ....................................................................... 18
3.4.4 Cytochromes .................................................................... 18
3.5 Iron Storage Compounds................................................................ 19
3.5.1 Ferritin .............................................................................. 19
3.5.2 H aemosiderin ................................................................... 20
3.6 Labile Iron Pool.............................................................................. 21
3.7 Physiological Iron Turnover ........................................................... 21
3.7.1 F rom Senile RBC ............................................................. 21
3.7.2 I n the Body ....................................................................... 22
References ................................................................................................. 23
xi
xii Contents
4 Iron Metabolism in Human Body .......................................................... 29
4.1 Introduction .................................................................................... 29
4.2 Dietary Sources of Iron .................................................................. 30
4.3 Nonconventional Sources of Iron ................................................... 30
4.3.1 Iron Utensils ..................................................................... 30
4.4 Iron Absorption .............................................................................. 31
4.4.1 Factors Affecting Iron Absorption .................................... 31
4.4.2 Non-haem Iron Absorption .............................................. 34
4.4.3 Haem Iron Absorption ...................................................... 36
4.5 Iron Transport in Blood Circulation ............................................... 37
4.6 Iron Uptake by Cells ...................................................................... 38
4.7 Regulation of Iron Absorption ....................................................... 39
4.7.1 Mucosal Block Mechanism .............................................. 39
4.7.2 E rythropoietin Stimulus ................................................... 40
4.7.3 Ferritin–Transferrin Receptor Translational Control ....... 40
4.7.4 Hepcidin Level ................................................................. 40
4.8 Role of Iron in the Growth and Development of Children ............. 40
4.8.1 Hypotheses for Iron Deficiency-Induced
Harmful Effects on Neurodevelopment ........................... 41
References ................................................................................................. 43
5 Aetiology of Iron Deficiency in Children .............................................. 47
5.1 Introduction .................................................................................... 48
5.2 Chronic Helminthic Infection ........................................................ 51
5.3 Helicobacter pylori Infection ......................................................... 58
5.4 Severe Malarial Anemia in Children .............................................. 61
5.4.1 Overview .......................................................................... 61
5.4.2 A etiopathogenesis of Severe Malarial
Anemia in Children .......................................................... 63
5.4.3 C linical Manifestations .................................................... 75
5.5 Environmental Enteropathy and Anemia in Children .................... 75
5.6 Malabsorption Syndrome ............................................................... 77
5.7 Habit of Geophagy in Children and Anemia.................................. 80
5.7.1 Overview of Geophagy .................................................... 80
5.7.2 Cross-sectional Research Study (1) ................................. 83
5.7.3 C ross-sectional Research Study (2) ................................. 85
5.8 HIV-Induced Anemia ..................................................................... 89
5.9 Iron Deficiency Anemia in Coeliac Disease ................................... 92
5.9.1 IL-6-Hepcidin-Hypoferraemia ......................................... 94
5.9.2 H epcidin-Induced Ferroportin Degradation ..................... 94
5.9.3 Erythrophagocytosis ......................................................... 94
References ................................................................................................. 95