Prevalence of micronutrient deficiencies across diverse environments in rural Madagascar

Authors: GOLDEN, CHRISTOPHER - Harvard University; ZAMBORAIN-MASON, JESSICA - Harvard University; LEVIS, ALEXANDER - Harvard University; RICE, BENJAMIN - Princeton University; Allen, Lindsay - A; HAMPEL, DANIELA - University Of California, Davis; HAZEN, JAMES - Catholic Relief Services; METCALF, JESSICA - Princeton University; RANDRIAMADY, HERVET - Harvard University; Shahab-Ferdows, Setti; WU, STEPHANIE - Harvard University; HANEUSE, SEBASTIEN - Harvard University

Submitted to: Frontiers in Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/18/2024
Publication Date: 5/16/2024
Citation: Golden, C.D., Zamborain-Mason, J., Levis, A., Rice, B.L., Allen, L.H., Hampel, D., Hazen, J., Metcalf, J.E., Randriamady, H.J., Shahab-Ferdows, S., Wu, S., Haneuse, S. 2024. Prevalence of micronutrient deficiencies across diverse environments in rural Madagascar. Frontiers in Nutrition. 11. https://doi.org/10.3389/fnut.2024.1389080.
DOI: https://doi.org/10.3389/fnut.2024.1389080

Interpretive Summary: Billions of people globally may be affected by micronutrient deficiencies. Madagascar is one of the countries that is considered to be especially nutritionally vulnerable, with almost half of the population stunted, and parts of the country facing near famine-like conditions. Although Madagascar is generally considered among the most undernourished of countries, biomarker data to validate these claims is extremely limited. We used data from three studies conducted between 2013 - 2018 with comprehensive biomarker profiles for 4581 individuals from 31 communities in five different ecological regions during at least one time-point. Estimated prevalences of nutrient deficiencies and inflammation across various regions of rural Madagascar were of concern for everyone, with 69.6% of the population estimated to be deficient in zinc, 15.6% deficient in vitamin B12, 15.5% deficient in vitamin A, and lower levels of iron deficiency (as indicated by 9.4% deficient in ferritin and 4.3% deficient in soluble transferrin receptor). Beyond nutrient biomarkers, 24.1% of the population showed signs of chronic inflammation based on high values of a-1-acid glycoprotein (AGP), and 12.4% of acute inflammation based on high values of C-reactive protein (CRP). There is a nearly 4-fold difference between the lowest and highest regional prevalence of vitamin B12 deficiency, a 6-fold difference in vitamin A deficiency, and a nearly 2-fold difference in acute inflammation (CRP) and deficiencies of zinc and iron (based on both ferritin and transferrin receptor), indicating strong geographical variations in micronutrient deficiencies across Madagascar.

Technical Abstract: It is estimated that billions of people around the world are affected by micronutrient deficiencies. Madagascar is considered to be particularly nutritionally vulnerable, with nearly half of the population stunted, and parts of the country facing near famine-like conditions. Although Madagascar is generally considered among the most undernourished of countries, empirical data in the form of biological samples to validate these claims is extremely limited. Our research drew data from three studies conducted between 2013 - 2018 and provided comprehensive biomarker profiles for 4581 individuals from 31 communities in five different ecological regions during at least one time-point. Estimated prevalences of nutrient deficiencies and inflammation across various regions of rural Madagascar were of concern for both sexes and across all ages, with 69.6% of the population estimated to be deficient in zinc, 15.6% deficient in vitamin B12, 15.5% deficient in retinol, and lower levels of iron deficiency (as indicated by 9.4% deficient in ferritin and 4.3% deficient in soluble transferrin receptor). Beyond nutrient biomarkers, nearly one quarter of the population (24.1%) exhibited chronic inflammation based on high values of a-1-acid glycoprotein, and 12.4% of the population exhibited acute inflammation based on high values of C-reactive protein. There is a nearly 4-fold difference between the lowest and highest regional prevalence of vitamin B12 deficiency, a 6-fold difference in retinol deficiency, and a nearly 2-fold difference in acute inflammation (CRP) and deficiencies of zinc and iron (based on both ferritin and transferrin receptor), highlighting strong geographical variations in micronutrient deficiencies across Madagascar.