INTRODUCTION Age-related cognitive disorders, including Alzheimer disease, are among the main causes of disability and dependence in older adults worldwide. High blood homocysteine levels (hyperhomocysteinemia) are a risk factor for diseases whose metabolism involves different B vitamins. Antioxidant vitamins provide a protective effect by mitigating oxidative stress generated by these diseases. Epidemiological studies have presented varying results on the relationships between blood levels of these vitamins and such cognitive disorders.

OBJECTIVE Evaluate the association of vitamin and homocysteine levels with mild cognitive impairment and Alzheimer disease in a group of Cuban older adults.

METHODS A cross-sectional study was conducted in Havana, Cuba, of 424 persons aged ≥65 years: 43 with Alzheimer disease, 131 with mild cognitive impairment, and 250 with no signs of cognitive impairment. Dementia was diagnosed using criteria of the International 10/66 Dementia Research Group and Diagnostic and Statistical Manual of Mental Disorders (DSM IV), and mild cognitive impairment was diagnosed using Petersen’s criteria. Blood levels of vitamins (thiamine, B-2, folate, B-12, C and A) and homocysteine were measured by standard procedures. Analysis of variance for continuous variables and percentage comparison tests for dichotomous variables were used to compare groups.

RESULTS Persons with Alzheimer disease presented significantly lower levels of vitamins B-2, C and A than healthy participants (p <0.05). Homocysteine levels were significantly higher in those with Alzheimer disease and mild cognitive impairment than in participants with no cognitive impairment (p <0.05). Statistically, levels of thiamine, folic acid, and vitamin B-12 were not significantly different across groups. Compared with those without cognitive impairment, prevalence rates (PR) in the Alzheimer group were significantly higher for hyperhomocysteinemia (PR = 3.26; 1.84–5.80) and deficiency of all B vitamins: thiamine (PR = 1.89; 1.04–3.43), B-2 (PR = 2.85; 1.54–5.26), folate (PR = 3.02; 1.53–5.95), B-12 (PR = 2.21; 1.17–4.19), vitamin C (PR = 3.88; 2.12–7.10) and A (PR = 5.47; 3.26–9.17). In mild cognitive impairment, prevalence rates were significantly higher for hyperhomocysteinemia (PR = 1.42; 1.08–1.87), vitamin B-2 deficiency (PR = 1.70; 1.24–2.32) and vitamin A deficiency (PR =1.88; 1.05–3.38).

CONCLUSIONS Hyperhomocysteinemia and various vitamin deficiencies are related to Alzheimer disease and mild cognitive impairment. Longitudinal studies are needed to further elucidate the relationship between different nutritional biomarkers and dementia. A better understanding of this relationship could provide a basis for therapeutic and preventive strategies.

KEYWORDS Vitamins, homocysteine, geriatrics, Alzheimer disease, cognitive impairment, Cuba

INTRODUCTION Iron deficiency is the main cause of anemia, but infections, inflammation and other factors also play a role. Anemia in women of childbearing age is a risk for pregnancy, childbirth and childhood development during the first two years of life. In Cuba, per WHO definition, anemia is a moderate public health problem in the third trimester of pregnancy and in preschoolers, with a prevalence of 21.6%, in both cases.

OBJECTIVE Estimate prevalence of anemia and iron deficiency in women of childbearing age and assess its relation to inflammation, overweight, central adiposity, H. pylori infection and ingestion of iron-rich foods and enhancers of iron absorption.

METHODS A cross-sectional, analytical study was performed in 391 women aged 18–40 years in four municipalities of Havana, Cuba, from February through June 2014. Variables (indicators in parentheses) were anemia (hemoglobin), iron deficiency (ferritin), nutritional status (body mass index and waist circumference), inflammation (C-reactive protein, acid alpha 1-glycoprotein and interleukin 6), H. pylori infection and ingestion of iron-rich foods. SPSS 20.0 and Epi Info 7.1.2.0 were used for statistical analysis.

RESULTS Anemia prevalence was 24.6% (96/391); iron deficiency, 68% (266/391); H. pylori infection, 47.1% (184/391); inflammation detected by C-reactive protein, 8.4 % (33/391) and by alpha-1-glycoprotein, 19.9% (78/391). Limited results are included for interleukin 6, which was determined in fewer cases (96). Excess body weight was found in 38.7% (150/388) and increased central adiposity in 26.7% (101/378). Iron deficiency was the main cause of anemia (OR 2.68). Central adiposity, excess body weight, and iron deficiency were positively associated with inflammation (OR of 1.77, 1.23 and 1.72, respectively), whereas H. pylori infection was negatively associated with iron deficiency and anemia (OR 0.75 and 0.94, respectively). Low consumption of meat (OR 1.17) and vegetables (OR 1.36) showed discrete limited positive associations with iron deficiency, as well as low consumption of eggs (OR 1.69) and vegetables (OR 1.56) with anemia.

CONCLUSIONS Anemia is a moderate public health problem in the studied group, but with iron deficiency present in two thirds of the population and associated with anemia. Risk factors for anemia and iron deficiency, such as menorrhagia and bacterial or viral infections, should be assessed in women of childbearing age, to support interventions needed to reduce risks in pregnancy and childbirth.

KEYWORDS Anemia, iron deficiency, women, women of childbearing age, inflammation, Helicobacter pylori, obesity, adiposity, Cuba

INTRODUCCIÓN La anemia constituye el principal problema nutricional en los niños preescolares cubanos. Tal situación estimuló la realización de intervenciones de salud por parte de las autoridades sanitarias cubanas con el propósito de prevenir y controlar la enfermedad. En 2008 se estableció una estrategia nacional integral que proporcionó atención particular a las provincias orientales del país, por constituir la región con los más grandes desafíos en los determinantes sociales de salud.

OBJETIVO Determinar la prevalencia de anemia en los niños de 6 a 59 meses en las cinco provincias orientales de Cuba en tres años diferentes dentro de una década, así como estudiar la asociación de la anemia con los factores epidemiológicos y nutricionales, para evaluar el impacto del Plan Integral Cubano para la Prevención y el Control de la Anemia por Deficiencia de Hierro en Cuba.

MÉTODOS Se realizaron estudios de corte transversal en muestras representativas de la población de los niños con 6 a 59 meses, residentes en las provincias orientales del país, en los años 2005, 2008 y 2011. Se midió el nivel de hemoglobina para diagnosticar la anemia (hemoglobina menor de 110 g/L) y los resultados se relacionaron con variables independientes tales como la edad, el sexo, el área de residencia (urbana o rural), la asistencia a círculos infantiles [guarderías para niños entre 1 y 5 años de edad, pertenecientes al Sistema Nacional de Educación de Cuba —Eds.], el peso al nacer, la historia de lactancia materna, así como la anemia materna durante el embarazo. Se calcularon las frecuencias de distribución, las comparaciones se evaluaron mediante la prueba de χ2 y los Odds Ratio (OR) con intervalos de confianza (IC) del 95%.

RESULTADOS La prevalencia de anemia en la región estudiada disminuyó de 31.8% en 2005 a 26% en 2011; en la mayoría de los casos era leve (hemoglobina = 100-109 g/L). La prevalencia fue superior en los niños de 6 a 23 meses comparado con los que tenían de 24 a 59 meses. No se encontró diferencia significativa en la prevalencia de anemia entre niños y niñas. La prevalencia fue superior en las áreas rurales comparadas con las áreas urbanas en 2005 (p = 0.026) y en 2011
(p = 0.012). La asistencia a círculos infantiles constituyó un factor protector en los tres años estudiados. El bajo peso al nacer solo estuvo asociado con la anemia en 2011 (OR 1.74, IC 1.04-2.92). La prevalencia de la lactancia materna de forma exclusiva durante los seis primeros meses de vida se incrementó durante el período de estudio y la anemia se asoció con la no utilización de lactancia materna exclusiva en 2005 (OR 1.57, IC 1.05-2.34). La anemia materna al inicio y durante el embarazo fue un factor de riesgo significativo tanto en 2005 (OR 1.98, IC 1.27-3.10) como en 2011 (OR 1.43, IC 1.05-1.94).

CONCLUSIONES Aunque la prevalencia de anemia disminuyó paulatinamente durante el período del estudio, la enfermedad continúa siendo un problema de salud pública en Cuba, por lo que se deben mantener y fortalecer las medidas para su prevención y su control, tales como realizar intervenciones de salud sobre las mujeres en edad reproductiva, la alimentación exclusiva por lactancia materna durante los primeros seis meses de edad, estimular el cumplimiento de las recomendaciones de las normas cubanas para la alimentación complementaria de los niños hasta los dos años de edad, así como continuar la evaluación y la investigación de las causas de la anemia en los niños en edad preescolar.

PALABRAS CLAVE Anemia, niños, preescolar, infantes, lactancia materna, círculos infantiles, guarderías, Cuba

INTRODUCTION Anemia is the main nutritional problem in Cuban preschool children, prompting several interventions to prevent and control it. An enhanced national strategy was established in 2008, and particular attention paid to the eastern provinces, the region with greatest challenges in social determinants of health.

OBJECTIVE Determine anemia prevalence in children aged 6–59 months in Cuba’s five eastern provinces in three separate years within a decade, as well as association of anemia with epidemiological and nutritional factors, to assess impact of Cuba’s Comprehensive Plan for Prevention and Control of Iron-Deficiency Anemia in Cuba.

METHODS Cross-sectional studies of children aged 6–59 months (completed) were conducted in 2005, 2008 and 2011. Hemoglobin levels were measured to diagnose anemia (hemoglobin <110 g/L) and data were collected on independent variables such as age, sex, area of residence (urban or rural), daycare center enrollment, birth weight, breastfeeding history, and maternal anemia during pregnancy. Frequency distributions were created and comparisons tested with the chi square, and odds ratios calculated with 95% confidence intervals.

RESULTS Anemia prevalence in the region fell from 31.8% in 2005 to 26% in 2011; most of cases were mild (hemoglobin: 100–109 g/L). Prevalence was higher in children aged 6–23 months than in those aged 24–59 months throughout. No significant differences were found in anemia prevalence between boys and girls. Prevalence was higher in rural than in urban areas in 2005 (p = 0.026) and 2011 (p = 0.012). Daycare enrollment emerged as a protective factor in all three years. Low birth weight was associated with anemia only in 2011 (OR 1.74, CI 1.04–2.92). Prevalence of exclusive breastfeeding for six months increased over the study period; lack of breastfeeding was found to be associated with anemia in 2005 (OR 1.57, CI 1.05–2.34). Maternal anemia at onset of and during pregnancy was a significant risk factor in 2005 (OR 1.98, CI 1.27–3.10) and 2011 (OR 1.43, CI 1.05–1.94).

CONCLUSIONS Although anemia prevalence steadily decreased over the study period, it continues to be a public health problem in Cuba and anemia prevention and control measures should be maintained and strengthened: interventions for women of childbearing age, fostering exclusive breastfeeding of infants through their sixth month, and encouraging compliance with recommendations on complementary feeding per Cuba’s nutritional guidelines for children aged <2 years. Further evaluation is needed to identify the causes of anemia in the population of preschool children.

KEYWORDS Anemia, children, preschool, infants, breastfeeding, child daycare centers, Cuba