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Haemoglobin thresholds to define anaemia in a national sample of healthy children and adolescents aged 1–19 years in India: a population-based study

BACKGROUND: WHO’s haemoglobin cutoffs to define anemia were based on five studies of predominantly White adult populations, done over 50 years ago. Therefore, a general re-examination of the existing haemoglobin cutoffs is warranted for global application, in representative healthy populations of ch...

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Autores principales: Sachdev, Harshpal Singh, Porwal, Akash, Acharya, Rajib, Ashraf, Sana, Ramesh, Sowmya, Khan, Nizamuddin, Kapil, Umesh, Kurpad, Anura V, Sarna, Avina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7612991/
https://www.ncbi.nlm.nih.gov/pubmed/33872581
http://dx.doi.org/10.1016/S2214-109X(21)00077-2
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author Sachdev, Harshpal Singh
Porwal, Akash
Acharya, Rajib
Ashraf, Sana
Ramesh, Sowmya
Khan, Nizamuddin
Kapil, Umesh
Kurpad, Anura V
Sarna, Avina
author_facet Sachdev, Harshpal Singh
Porwal, Akash
Acharya, Rajib
Ashraf, Sana
Ramesh, Sowmya
Khan, Nizamuddin
Kapil, Umesh
Kurpad, Anura V
Sarna, Avina
author_sort Sachdev, Harshpal Singh
collection PubMed
description BACKGROUND: WHO’s haemoglobin cutoffs to define anemia were based on five studies of predominantly White adult populations, done over 50 years ago. Therefore, a general re-examination of the existing haemoglobin cutoffs is warranted for global application, in representative healthy populations of children and adults. Such data are scarce in low-income and middle-income countries; however, a 2019, large-scale, nationally representative survey of children and adolescents aged 0–19 years in India (Comprehensive National Nutrition Survey [CNNS]) offered an opportunity for this re-examination. Using this survey, we aimed to assess the age-specific and sex-specific percentiles of haemoglobin and cutoffs to define anaemia in the CNNS population. METHODS: For this population-based study, we constructed age-specific and sex-specific haemoglobin percentiles from values reported for a defined healthy population in the CNNS, which used rigorous quality control measures during sample collection and in the laboratory analyses. To obtain a healthy population, we excluded participants with iron, folate, vitamin B12, and retinol deficiencies; inflammation; variant haemoglobins (haemoglobin A(2) and haemoglobin S); and history of smoking. We considered age-specific and sex-specific 5th percentiles of haemoglobin derived for this healthy population as the study cutoff to define anaemia. We compared these with existing WHO cutoffs to assess significant differences between them at each year of age and sex for quantifying the prevalence of anaemia in the entire CNNS sample. FINDINGS: Between Feb 24, 2016, and Oct 26, 2018, the CNNS survey collected blood samples from 49 486 individuals. 41 210 participants had a haemoglobin value, 8087 of whom were included in our study and comprised the primary analytical sample. Compared with existing WHO cutoffs, the study cutoffs for haemoglobin were lower at all ages, usually by 1–2 g/dL, but more so in children of both sexes aged 1–2 years and in girls aged 10 years or older. Aanemia prevalence with the study cutoffs was 19·2 percentage points lower than with WHO cutoffs in the entire CNNS sample with valid haemoglobin values across all ages and sexes (10·8% with study cutoffs vs 30·0% with WHO cutoffs). INTERPRETATION: These findings support the re-examination of WHO haemoglobin cutoffs to define anaemia. Our haemoglobin reference percentiles, derived from healthy participants in a large representative Indian survey, are suitable for national use in India. Substantial variations in the 5th percentile of haemoglobin values across the 1–19 years age range and between sexes argue against constructing common cutoffs in stratified age groups for convenience. FUNDING: None.
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spelling pubmed-76129912022-07-05 Haemoglobin thresholds to define anaemia in a national sample of healthy children and adolescents aged 1–19 years in India: a population-based study Sachdev, Harshpal Singh Porwal, Akash Acharya, Rajib Ashraf, Sana Ramesh, Sowmya Khan, Nizamuddin Kapil, Umesh Kurpad, Anura V Sarna, Avina Lancet Glob Health Article BACKGROUND: WHO’s haemoglobin cutoffs to define anemia were based on five studies of predominantly White adult populations, done over 50 years ago. Therefore, a general re-examination of the existing haemoglobin cutoffs is warranted for global application, in representative healthy populations of children and adults. Such data are scarce in low-income and middle-income countries; however, a 2019, large-scale, nationally representative survey of children and adolescents aged 0–19 years in India (Comprehensive National Nutrition Survey [CNNS]) offered an opportunity for this re-examination. Using this survey, we aimed to assess the age-specific and sex-specific percentiles of haemoglobin and cutoffs to define anaemia in the CNNS population. METHODS: For this population-based study, we constructed age-specific and sex-specific haemoglobin percentiles from values reported for a defined healthy population in the CNNS, which used rigorous quality control measures during sample collection and in the laboratory analyses. To obtain a healthy population, we excluded participants with iron, folate, vitamin B12, and retinol deficiencies; inflammation; variant haemoglobins (haemoglobin A(2) and haemoglobin S); and history of smoking. We considered age-specific and sex-specific 5th percentiles of haemoglobin derived for this healthy population as the study cutoff to define anaemia. We compared these with existing WHO cutoffs to assess significant differences between them at each year of age and sex for quantifying the prevalence of anaemia in the entire CNNS sample. FINDINGS: Between Feb 24, 2016, and Oct 26, 2018, the CNNS survey collected blood samples from 49 486 individuals. 41 210 participants had a haemoglobin value, 8087 of whom were included in our study and comprised the primary analytical sample. Compared with existing WHO cutoffs, the study cutoffs for haemoglobin were lower at all ages, usually by 1–2 g/dL, but more so in children of both sexes aged 1–2 years and in girls aged 10 years or older. Aanemia prevalence with the study cutoffs was 19·2 percentage points lower than with WHO cutoffs in the entire CNNS sample with valid haemoglobin values across all ages and sexes (10·8% with study cutoffs vs 30·0% with WHO cutoffs). INTERPRETATION: These findings support the re-examination of WHO haemoglobin cutoffs to define anaemia. Our haemoglobin reference percentiles, derived from healthy participants in a large representative Indian survey, are suitable for national use in India. Substantial variations in the 5th percentile of haemoglobin values across the 1–19 years age range and between sexes argue against constructing common cutoffs in stratified age groups for convenience. FUNDING: None. 2021-06-01 2021-04-16 /pmc/articles/PMC7612991/ /pubmed/33872581 http://dx.doi.org/10.1016/S2214-109X(21)00077-2 Text en https://creativecommons.org/licenses/by/4.0/This is an Open Access article under the CC BY 4.0 license. (https://creativecommons.org/licenses/by/4.0/)
spellingShingle Article
Sachdev, Harshpal Singh
Porwal, Akash
Acharya, Rajib
Ashraf, Sana
Ramesh, Sowmya
Khan, Nizamuddin
Kapil, Umesh
Kurpad, Anura V
Sarna, Avina
Haemoglobin thresholds to define anaemia in a national sample of healthy children and adolescents aged 1–19 years in India: a population-based study
title Haemoglobin thresholds to define anaemia in a national sample of healthy children and adolescents aged 1–19 years in India: a population-based study
title_full Haemoglobin thresholds to define anaemia in a national sample of healthy children and adolescents aged 1–19 years in India: a population-based study
title_fullStr Haemoglobin thresholds to define anaemia in a national sample of healthy children and adolescents aged 1–19 years in India: a population-based study
title_full_unstemmed Haemoglobin thresholds to define anaemia in a national sample of healthy children and adolescents aged 1–19 years in India: a population-based study
title_short Haemoglobin thresholds to define anaemia in a national sample of healthy children and adolescents aged 1–19 years in India: a population-based study
title_sort haemoglobin thresholds to define anaemia in a national sample of healthy children and adolescents aged 1–19 years in india: a population-based study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7612991/
https://www.ncbi.nlm.nih.gov/pubmed/33872581
http://dx.doi.org/10.1016/S2214-109X(21)00077-2
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