Frequency of small fish consumption is associated with improved iron and hemoglobin in young Malawian children

Authors: WERNER, E.ROCHELLE - University Of California, Davis; Caswell, Bess; ARNOLD, CHARLES - University Of California, Davis; IANNOTTI, LORA - Washington University; MALETA, KENNETH - University Of Malawi; STEWART, CHRISTINE - University Of California, Davis

Submitted to: Current Developments in Nutrition
Publication Type: Abstract Only
Publication Acceptance Date: 3/14/2022
Publication Date: 6/14/2022
Citation: Werner, E., Caswell, B.L., Arnold, C., Iannotti, L.L., Maleta, K.M., Stewart, C.P. 2022. Frequency of small fish consumption is associated with improved iron and hemoglobin in young Malawian children. Current Developments in Nutrition. 6/615. https://doi.org/10.1093/cdn/nzac060.073.
DOI: https://doi.org/10.1093/cdn/nzac060.073

Interpretive Summary: Objectives: Our objective was to assess whether fish and meat consumption over 6mo was associated with plasma ferritin, soluble transferrin receptor (sTfR), hemoglobin, iron deficiency (ID), and anemia in a population of young children previously found to have primarily plant-based, iron-inadequate diets and >50% prevalence of iron deficiency anemia. Methods: This secondary data analysis includes 585 Malawian infants from an egg feeding trial. Children were enrolled at 6-9 mo old and followed for 6mo. At enrollment and 6mo follow-up, 24hr dietary recalls and blood draws were conducted. Caregivers of enrolled children completed weekly 7-day food frequency questionnaires, indicating days of any small fish, large fish or meat consumption. The percent of days in which small fish, large fish, or meat were consumed, and percent of weeks with any fish or meat consumption, were totaled for each child. Plasma ferritin, sTfR, and hemoglobin were assessed for associations with the percent of days with small fish, large fish, and meat intake using linear regression. Prevalence ratios (PR) of ID (ferritin<12µg/L or sTfR>8.3mg/L) and anemia (hemoglobin<11g/dL) were compared for each flesh food category using log binomial or modified Poisson regression. Results: The percent of children with observed intake of small fish (4%), large fish (1%), and meat (2%) from 24-hr recalls at enrollment increased to 40%, 12%, and 9%, respectively, at the 6mo follow-up. Over 6mo, children averaged consumption of small fish, large fish, and meat on 25%, 8%, and 6% of days, respectively, and flesh foods on 75% of weeks. More frequent intake of small fish was associated with higher hemoglobin [geometric mean ratio (95%CI) per 10% difference: 1.01 g/dL (1.00, 1.01)] and lower sTfR [0.98 mg/L (0.96, 1.00)] but was not associated with ferritin concentration [1.03 µg/L (0.99, 1.07)]; nor was it associated with the prevalence of ID [PR(95%CI): 0.99 (0.97, 1.01)] or anemia [0.94 (0.88, 1.01)]. More frequent consumption of large fish was associated with a higher prevalence of anemia [1.09 per 10% difference in frequency, (1.00, 1.18)]. Meat consumption was predominantly chicken and not associated with iron or anemia indices. Conclusions: Small fish are a primary contributor to total flesh food intake of young Malawian children and may provide modest improvements to iron status and hemoglobin.

Technical Abstract: Objectives: Our objective was to assess whether fish and meat consumption over 6mo was associated with plasma ferritin, soluble transferrin receptor (sTfR), hemoglobin, iron deficiency (ID), and anemia in a population of young children previously found to have primarily plant-based, iron-inadequate diets and >50% prevalence of iron deficiency anemia. Methods: This secondary data analysis includes 585 Malawian infants from an egg feeding trial. Children were enrolled at 6-9 mo old and followed for 6mo. At enrollment and 6mo follow-up, 24hr dietary recalls and blood draws were conducted. Caregivers of enrolled children completed weekly 7-day food frequency questionnaires, indicating days of any small fish, large fish or meat consumption. The percent of days in which small fish, large fish, or meat were consumed, and percent of weeks with any fish or meat consumption, were totaled for each child. Plasma ferritin, sTfR, and hemoglobin were assessed for associations with the percent of days with small fish, large fish, and meat intake using linear regression. Prevalence ratios (PR) of ID (ferritin<12µg/L or sTfR>8.3mg/L) and anemia (hemoglobin<11g/dL) were compared for each flesh food category using log binomial or modified Poisson regression. Results: The percent of children with observed intake of small fish (4%), large fish (1%), and meat (2%) from 24-hr recalls at enrollment increased to 40%, 12%, and 9%, respectively, at the 6mo follow-up. Over 6mo, children averaged consumption of small fish, large fish, and meat on 25%, 8%, and 6% of days, respectively, and flesh foods on 75% of weeks. More frequent intake of small fish was associated with higher hemoglobin [geometric mean ratio (95%CI) per 10% difference: 1.01 g/dL (1.00, 1.01)] and lower sTfR [0.98 mg/L (0.96, 1.00)] but was not associated with ferritin concentration [1.03 µg/L (0.99, 1.07)]; nor was it associated with the prevalence of ID [PR(95%CI): 0.99 (0.97, 1.01)] or anemia [0.94 (0.88, 1.01)]. More frequent consumption of large fish was associated with a higher prevalence of anemia [1.09 per 10% difference in frequency, (1.00, 1.18)]. Meat consumption was predominantly chicken and not associated with iron or anemia indices. Conclusions: Small fish are a primary contributor to total flesh food intake of young Malawian children and may provide modest improvements to iron status and hemoglobin.