Background: Despite efforts to reduce iron deficiency through Supplemental Nutrition Programs for Women Infants and Children (WIC) funded by the USDA, the prevalence of anemia in children at some WIC sites has been found to be greater than 30%. This study will examine the causes of anemia in children 12-35 months old who participate in the WIC program at two sites in St. Louis, Missouri and will identify medical, dietary and behavioral risk factors for iron deficiency anemia.
Aims: The specific aims of the study are: (1) to determine the true prevalence of anemia among children 12-35 months old WIC participants; (2) to determine the proportion of anemia among WIC participants due to iron deficiency; (3) to determine the proportion of anemia due to causes other than iron deficiency; and (4) to examine the dietary, behavioral and demographic correlates of iron status based on questionnaire responses as well as hemoglobinopathies, based on hemoglobin electrophoresis and when indicated, high performance liquid chromatography. Acute illness inflammation will also be assessed, based on questionnaire responses and C-reactive protein.

Methods: All children 12-35 months of age who present for certification and re-certification or voucher pick-up in the selected WIC clinics and whose primary caregivers agree to participate in the study, will be included. A total of 1000 children will be sampled. After explaining the study to the parent/guardian, an interviewer will obtain an informed consent and administer a questionnaire. The data to be collected will include demographic information, history of acute illness at the time of enrollment or within two weeks prior to enrollment as well as dietary information including history of infant feeding, timing of introduction of foods that may affect iron levels, and frequency of food intake for all children. A pediatric phlebotomist will collect blood samples. Children with anemia and abnormal hemoglobin traits will be referred to their primary care givers, following local WIC clinic procedures for referral. The project co-investigators in conjunction with CDC will perform data analysis. CDC will provide technical assistance and oversight and the CDC Nutritional Biochemistry Branch Laboratory will conduct the laboratory tests. This study protocol was originally developed by the Maternal Child Nutrition Bureau of the National Center of Chronic Diseases Prevention and Health Promotion, Centers for Disease Control.

Innovations & Dissemination: This study is innovative in its design with regard to the possibility of determining respective proportions of anemia that are attributable to the various risk factors associated with anemia in children 12-23 months old. Study findings will be disseminated in collaboration with co-investigators at the School of Public Health, local and state health agencies. Reports will be disseminated in lay and professional meetings as well as publications. Overall, the findings will inform planning and design of appropriate intervention strategies to reduce anemia in this population.