Stunted and ferritin levels in children aged 0-24 months: Does gender influence the incidence?
Keywords:
Ferritin, Stunting, Growth Faltering, Iron StorageAbstract
Background and aim: Stunting is still a global nutritional problem in developing countries such as Indonesia. Iron deficiency occurs in the stunting population due to the depletion of iron stored and stimulates hypoxia in hepatic cells which lead to the inhibition of protein synthesis, including IGF-1. Serum ferritin, the stored form of iron, is a sensitive marker for iron storage detection. This study was conducted to access growth faltering, stunting, and ferritin levels in children under 2 years old.
Methods: A cross-sectional study was performed using secondary data taken from medical records of children aged under 2 years old who were visiting Nutrition and Metabolic Diseases doctors in outpatients of Husada Utama Hospital from July 2018 until June 2020. All data were analyzed using SPSS ver. 21.0 (IBM, UK), including the test of normality and homogeneity, independent sample T-test (or Mann-Whitney U Test), Chi-square test, and Fischer exact. Bivariate analysis was conducted to determine the relationship between variables.
Results: 44.83% (52 subjects) were undernourished. The incidence of stunted/severely stunted was more frequent in males than females (44.83% or 26 subjects vs. 25.86% or 15 subjects). Ferritin level was significantly lower in males than females (29.69 + 24.80 vs. 53.38 + 95.36 µg/dl, P=0.011). There was a weak negative correlation between low-level ferritin with sex (r=-0.184, P=0.048). Being male had a 2.450-fold risk of low-level ferritin (95% CI [0.994-6.042], P=0.052). For the incidence of stunted, being male had a 2.329-fold risk of stunted (95% CI [1.064-5.097], P=0.034). Stunted did not correlate with a low level of ferritin (r=0.066, P=0.478).
Conclusions: There was a correlation between sex with low levels of ferritin. Males were at risk of low-level ferritin and stunted in young children aged 0-24 months old.
References
Oot L, Sethuraman K, Ross J, Sommerfelt AE. Effect of Chronic Malnutrition (Stunting) on Learning Ability, a Measure of Human Capital: A Model in PROFILES for Country-Level Advocacy [Internet]. Technical Brief, Food and Nutrition Technical Assistance III Project. 2016. Available from: https://www.fantaproject.org/sites/default/files/resources/PROFILES-brief-stunting-learning-Feb2016.pdf
Emond AM, Blair PS, Emmett PM, Drewett RF. Weight faltering in infancy and IQ levels at 8 years in the Avon Longitudinal Study of Parents and Children. Pediatrics. 2007 Oct;120(4):e1051-8. doi: 10.1542/peds.2006-2295.
Budiastutik I, Rahfiludin MZ. Faktor Risiko Stunting pada Anak di Negara Berkembang. Amerta Nutr. 2019;3:122–9.
Soliman AT, Al Dabbagh MM, Habboub AH, Adel A, Humaidy NA, Abushahin A. Linear growth in children with iron deficiency anemia before and after treatment. J Trop Pediatr. 2009 Oct;55(5):324-7. doi: 10.1093/tropej/fmp011.
Dewi EK, Nindya TS. Hubungan Tingkat Kecukupan Zat Besi Dan Seng Dengan Kejadian Stunting Pada Balita 6-23 Bulan. Amerta Nutr. 2017;1:361.
Soliman AT, De Sanctis V, Yassin M, Adel A. Growth and Growth hormone - Insulin Like Growth Factor -I (GH-IGF-I) Axis in Chronic Anemias. Acta Biomed. 2017 Apr 28;88(1):101-111. doi: 10.23750/abm.v88i1.5744.
De Sanctis V, Soliman AT, Alaaraj N, Ahmed S, Alyafei F, Hamed N. Early and Long-term Consequences of Nutritional Stunting: From Childhood to Adulthood. Acta Biomed. 2021;92. doi:10.23750/abm.v92i1.11346
Odei Obeng-Amoako GA, Myatt M, Conkle J, et al. Concurrently wasted and stunted children 6-59 months in Karamoja, Uganda: prevalence and case detection. Matern Child Nutr. 2020 Oct;16(4):e13000. doi: 10.1111/mcn.13000.
Gwela A, Mupere E, Berkley JA, Lancioni C. Undernutrition, Host Immunity and Vulnerability to Infection Among Young Children. Pediatr Infect Dis J. 2019 Aug;38(8):e175-e177. doi: 10.1097/INF.0000000000002363.
Black RE, Victora CG, Walker SP, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382:427-51. doi: 10.1016/S0140-6736(13)60937-X.
Engidaye G, Aynalem M, Adane T, Gelaw Y, Yalew A, Enawgaw B. Undernutrition and its associated factors among children aged 6 to 59 months in Menz Gera Midir district, Northeast Ethiopia: A community-based cross-sectional study. PLoS One. 2022 Dec 6;17(12):e0278756. doi: 10.1371/journal.pone.0278756.
Shah B, Tombeau Cost K, Fuller A, Birken CS, Anderson LN. Sex and gender differences in childhood obesity: contributing to the research agenda. BMJ Nutr Prev Health. 2020 Sep 9;3(2):387-390. doi: 10.1136/bmjnph-2020-000074.
Brogan P, Eleftheriou D, Dillon M. Small vessel vasculitis. Pediatr Nephrol. 2010 Jun;25(6):1025-35. doi: 10.1007/s00467-009-1317-4.
Fatima S, Manzoor I, Joya AM, Arif S, Qayyum S. Stunting and associated factors in children of less than five years: A hospital-based study. Pakistan J Med Sci. 2020;36:581–5.
Ramli A, Agho KE, Inder KJ, Bowe SJ, Jacobs J, Dibley MJ. Prevalence and risk factors for stunting and severe stunting among under-fives in North Maluku province of Indonesia. BMC Pediatr. 2009;9:64.
Habimana S, Biracyaza E. Risk factors of stunting among children under 5 years of age in the Eastern and Western Provinces of Rwanda: analysis of Rwanda demographic and health survey 2014/2015. Pediatr Heal Med Ther. 2019;10:115–30. doi: 10.2147/PHMT.S222198.
Vonaesch P, Tondeur L, Breurec S, et al. Factors associated with stunting in healthy children aged 5 years and less living in Bangui (RCA). PLoS One. 2017;12. doi: 10.1371/journal.pone.0182363.
Thurstans S, Opondo C, Seal A, et al. Boys are more likely to be undernourished than girls: A systematic review and meta-analysis of sex differences in undernutrition. BMJ Glob Heal. 2020;5
Thurstans S, Opondo C, Seal A, et al. Understanding Sex Differences in Childhood Undernutrition: A Narrative Review. Nutrients. 2022;14:1–15.
Antunes H, Santos C, Carvalho S, Gonçalves S, Costa-Pereira A. Male gender is an important clinical risk factor for iron deficiency in healthy infants. ESPEN J. 2012;7
Wieringa FT, Berger J, Dijkhuizen MA, et al. Sex differences in prevalence of anaemia and iron deficiency in infancy in a large multi-country trial in South-East Asia. Br J Nutr. 2007 Nov;98(5):1070-6. doi: 10.1017/S0007114507756945.
Woodhead JC, Drulis JM, Nelson SE, Janghorbani M, Fomon SJ. Gender-related differences in iron absorption by preadolescent children. Pediatr Res. 1991 May;29(5):435-9. doi: 10.1203/00006450-199105010-00005.
Tamura T, Hou J, Goldenberg RL, Johnston KE, Cliver SP. Gender difference in cord serum ferritin concentrations. Biol Neonate. 1999;75(6):343-9. doi: 10.1159/000014114.
Santosa Q, Hadisaputro S, Soejoenoes A. Status Besi Bayi Baru Lahir dan Kadar Hepsidin Tali Pusat Berdasarkan Jenis Kelamin. J Kedokt Brawijaya. 2020;31:58–65.
Guo Y, Yu L, Wu ZY, Deng YH, Wu JL. Gender-specific association between serum ferritin and neurodevelopment in infants aged 6 to 12 months. Sci Rep. 2023 Feb 13;13(1):2490. doi: 10.1038/s41598-023-29690-x.
Domellöf M, Lönnerdal B, Dewey KG, Cohen RJ, Rivera LL, Hernell O. Sex differences in iron status during infancy. Pediatrics. 2002 Sep;110(3):545-52. doi: 10.1542/peds.110.3.545.
Wieringa FT, Berger J, Dijkhuizen MA, et al. Sex differences in prevalence of anaemia and iron deficiency in infancy in a large multi-country trial in South-East Asia. Br J Nutr 2007; 98: 1070–1076. doi: 10.1017/S0007114507756945.
Woodhead JC, Drulis JM, Nelson SE, et al. Gender-related differences in iron absorption by preadolescent children. Pediatr Res 1991; 29: 435–439. doi: 10.1203/00006450-199105010-00005.
Tamura T, Hou J, Goldenberg RL, et al. Gender difference in cord serum ferritin concentrations. Biol Neonate 1999; 75: 343–349. doi: 10.1159/000014114.
Santosa Q, Hadisaputro S, Soejoenoes A. Status Besi Bayi Baru Lahir dan Kadar Hepsidin Tali Pusat Berdasarkan Jenis Kelamin. J Kedokt Brawijaya 2020; 31: 58–65. doi: 10.21776/ub.jkb.2020.031.01.12 58.
Guo Y, Yu L, Wu ZY, et al. Gender-specific association between serum ferritin and neurodevelopment in infants aged 6 to 12 months. Sci Rep 2023; 13: 1–8. doi: 10.1038/s41598-023-29690-x.
Domellöf M, Lönnerdal B, Dewey KG, et al. Sex differences in iron status during infancy. Pediatrics 2002; 110: 545–552. doi: 10.1542/peds.110.3.545.
Agho KE, Chitekwe S, Rijal S, et al. Association between Child Nutritional Anthropometric Indices and Iron Deficiencies among Children Aged 6–59 Months in Nepal. Nutrients 2024; 16: 1–14. doi: 10.3390/nu16050698.
Gaston RT, Habyarimana F, Ramroop S. Joint modelling of anaemia and stunting in children less than five years of age in Lesotho: a cross-sectional case study. BMC Public Health 2022; 22: 1–11. doi: 10.1186/s12889-022-12690-3.
Suteerojntrakool O, Khongcharoensombat T, Chomtho S, et al. Anthropometric Markers and Iron Status of 6-12-Year-Old Thai Children: Associations and Predictors. J Nutr Metab 2021; 2021: 9629718. doi: 10.1155/2021/9629718. eCollection 2021.
Mutumba R, Mbabazi J, Pesu H, et al. Micronutrient Status and Other Correlates of Hemoglobin among Children with Stunting: A Cross-Sectional Study in Uganda. Nutrients; 15. Epub ahead of print 2023. doi: 10.3390/nu15173785.
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