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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

  1. Scott EM, Wright RC, Hannan BT. Anemia in Alaskan Eskimos. J Nutr 1955;55:137-49.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. Dallman PR, Siimes MA, Stekel A. Iron deficiency in infancy and childhood. Am J Clin Nutr 1980;33:86-118.

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