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Dietary factors moderate the relationship between groundwater iron and anemia in women and children in rural Bangladesh

Amanda S Wendt, Jillian L Waid, Sabine Gabrysch
Current Developments in Nutrition ; doi:10.1093/cdn/nzz093

Abstract: Background Anemia affects around 1.6 billion people worldwide, often due to iron deficiency. In Bangladesh, high levels of anemia have been observed alongside little iron deficiency. Elevated levels of groundwater iron could constitute a significant source of dietary iron. Objective We aimed to quantify the effect of groundwater iron on anemia in non-pregnant women and young children in Bangladesh, taking into account dietary factors that may affect iron absorption. Methods We analyzed data on 1,871 non-pregnant women and 987 children (6–37 m) from the 2015 baseline survey of the Food and Agricultural Approaches to Reducing Malnutrition cluster-randomized trial (clinicaltrials.gov ID: NCT02505711) in Sylhet, Bangladesh. We used logistic regression with robust standard errors to assess effects of self-reported groundwater iron, dietary intake, and sociodemographic characteristics on anemia, considering interactions between groundwater iron and dietary factors. Results Groundwater iron presence was associated with less anemia in women (OR: 0.74, 95% CI: 0.60, 0.90) and children (OR: 0.58, 95% CI: 0.44, 0.76). This effect was modified by dietary factors. In women, the effect of groundwater iron on anemia was stronger if no vitamin C-rich or heme-iron foods were consumed, and there was a clear dose-response relationship. In children, vitamin C-rich food intake strengthened the effect of groundwater iron on anemia, while there was no evidence for interaction by iron-rich foods. Conclusions Heme-iron and vitamin C consumption reduced the effect of groundwater iron on anemia among women but not children in Bangladesh, which may be due to higher levels of iron deficiency and lower iron intakes among children. Vitamin C consumption appears to enhance iron absorption from groundwater in children and they may thus benefit from consuming more vitamin C-rich fruits and vegetables. Even among women and children consuming heme-iron or vitamin C-rich foods and groundwater iron, anemia prevalence remained elevated, pointing to additional causes of anemia beyond iron deficiency.
Keywords: Children / Bangladesh / iron absorption / iron and anemia in women / groundwater iron on anemia

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