The influence of vitamin A status on iron-deficiency anaemia in anaemic adolescent schoolgirls in Myanmar

Objective: The present study was conducted to investigate reasons for the high prevalence of anaemia among adolescent schoolgirls and to elucidate the role of vitamin A in contributing to Fe-deficiency anaemia (IDA). Design: Among 1269 schoolgirls who were previously screened for anaemia (Hb < 120 g/l), 391 anaemic girls were further assessed for Fe, vitamin A and subclinical inflammation status. Fe and vitamin A indicators were corrected for inflammation and were compared in the Fe-deficient and non-deficient groups as well as between those with and without inflammation. Logistic regression was done to determine whether vitamin A status and subclinical inflammation were risk factors for Fe deficiency. The differences in Fe status among tertiles of vitamin A concentrations were assessed using ANOVA. Setting: Myanmar. Subjects: Adolescent schoolgirls (n 391). Results: One-third of the anaemia (30.4%) was IDA. Prevalence of low vitamin A status (serum retinol <1.05 μmol/l) was 31.5%. Fe and vitamin A status were significantly different between the IDA and non-IDA groups and also based on their inflammation status. Logistic regression showed that low vitamin A status was a significant predictor for being Fe deficient (OR = 1.81; 95% CI 1.03, 3.19 and OR = 2.31; 1.31, 4.07 in the middle (1.056-1.298 μmol/l) and low (≤1.056 μmol/l) vitamin A tertiles, respectively). ANOVA showed that better Fe status was associated with a higher concentration of serum retinol but only in IDA. Conclusions: Fe deficiency was not the main cause of anaemia in the present population. The role of vitamin A as well as other micronutrients should be taken into account in addressing the problem of anaemia.