High Prevalence of Anemia with Lack of Iron Deficiency among Women in Rural Bangladesh: A Role for Thalassemia and Iron in Groundwater

近期調查顯示孟加拉部分鄉村地區的婦女中非鐵缺乏的貧血盛行率達57%，推測有其他因素造成低濃度的血色素值。本研究評估地中海貧血症、地下水中的砷及鐵、以及飲食對於孟加拉鄉村地區的育齡婦女貧血的相關影響。個案來自於先前的產前營養介入試驗的孟加拉鄉村婦女，計207位的參與者於2008年接受2次面訪。資料收集包括7天的飲食頻率問卷、24小時飲用水攝取回憶記錄、7天的疾病史、體位測量以及飲用水中的砷及鐵濃度。血液分析項目包括鐵（血漿儲鐵蛋白、水溶性運鐵蛋白受體）、發炎反應（C-反應蛋白）及地中海貧血症（β地中海型貧血及血色素E）的狀態。在分層、校正分析結果顯示只有生產次數與地中海貧血患者（盛行率28%）的貧血有顯著相關（OR：11.34，95% CI：1.94，66.15）。相反地，地下水的鐵攝取量每天高於30毫克（OR：0.48，95% CI：0.24，0.96）及消瘦（OR：2.32，95% CI：1.17，4.62）與無地中海貧血症者的貧血具有顯著相關。高的地下水砷濃度（12%的管井含量高於50 μg/L）或多樣化的飲食與無論是否有地中海貧血診斷的貧血都不具相關。在孟加拉典型鄉村地區的婦女，由於地下水中含有高量的鐵，故缺鐵性貧血較少見；然而偏高的地中海貧血症盛行率，卻是貧血的高風險因子。在這樣的情境下，環境來源鐵的影響及地中海貧血症導致貧血的重要角色，在族群的層次上有可能是被忽視的。

關鍵字

孟加拉；貧血；鐵缺乏；地中海貧血症；婦女

並列摘要

Iron deficiency was absent in a recent population assessment of rural Bangladeshi women exhibiting anemia (57%), suggesting other causes of low hemoglobin. We assessed the relative influence on anemia of thalassemia, groundwater arsenic and iron, and diet among women of reproductive age living in rural Bangladesh. Women (n=207) sampled from a previous antenatal nutrient intervention trial in rural Bangladesh were visited during two seasons in 2008. Collected data included 7-day dietary and 24-hour drinking water intake recalls, 7-day morbidity recall, anthropometry, and drinking water arsenic and iron concentrations. Capillary blood was analyzed for iron (plasma ferritin, soluble transferrin receptor), inflammation (C-reactive protein) and thalassemia (β thalassemia and Hb E) status. In stratified, adjusted analyses, only parity was associated with anemia (odds ratio, OR (95% CI): 11.34 (1.94, 66.15)) for those with thalassemia (28% prevalent). In contrast, groundwater iron intake (＞30 mg/d, 0.48 (0.24, 0.96)) and wasting (2.32 (1.17, 4.62)) were associated with anemia among those without thalassemia. Elevated groundwater arsenic (＞50 μg/L, 12% of tubewells) and a diverse diet were unrelated to anemia regardless of thalassemia diagnosis (p＞0.70 and ＞0.47, respectively). Among women in this typical rural Bangladeshi area, the prevalence of thalassemia was high and, unlike iron deficiency which was absent most likely due to high iron intake from groundwater, contributed to the risk of anemia. In such settings, the influence of environmental sources of iron and the role of thalassemias in contributing to anemia at the population level may be underappreciated.

並列關鍵字

Bangladesh ； anemia ； iron-deficiency ； thalassemia ； women

國際替代計量

High Prevalence of Anemia with Lack of Iron Deficiency among Women in Rural Bangladesh: A Role for Thalassemia and Iron in Groundwater

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