Use of dietary screening for iron deficiency anemia - Tips from Other Journals

Author: Grace Brooke Huffman
Date: May 1, 1997

Anemia is prevalent in low-income urban children. Boutry and Needlman conducted a cross-sectional study to determine the association between diet history and microcytic anemia and to assess whether a brief dietary history could be used effectively to screen for microcytic anemia.

Children included in the study were between 15 and 60 months of age. Exclusion criteria included medical problems that could cause hematologic changes, such as failure to thrive, hemoglobinopathies or elevated lead levels. The parent of each child included in the study was asked three questions: (1) "Does your child eat meat, cereals or bread, vegetables and fruit at least five times a week?", (2) "Does he or she drink more than 16 oz of milk per day?" and (3) "Does he or she eat chips, fried snacks or sweets, or drink more than two glasses of pop daily?" Deficiency was diagnosed if the answer was "no" to the first question or "yes" to either of the last two questions. The children's blood was tested for red cell indexes and lead levels. Ferritin levels were checked in children diagnosed with dietary deficiency.

Of the 305 children included in the study, all but three were black, most (56 percent) were boys and all were receiving federal Aid to Families with Dependent Children. Eight percent of the children were found to have microcytic anemia. This finding was consistent with the findings of previous studies. Similarly, 12 percent of children were found to have low hemoglobin levels (with or without a low mean corpuscular volume). The screening questions for dietary history had a sensitivity of 71 percent and a specificity of 79 percent. Only 3 percent of children who did not have dietary deficiency as determined by the screening questions for dietary history were found to actually have microcytic anemia. Only two children who had documented iron deficiency were not identified by the screening questions.

The authors maintain that the dietary questions they have proposed to use as a screening tool for iron deficiency anemia are easier to use and more reliable than surveys that require use of computer programs or food recall questionnaires. This method allows the physician to recommend dietary changes rather than to prescribe iron supplementation, thereby improving overall health and preventing recurrence.

Boutry M, Needlman R. Use of diet history in the screening of iron deficiency. Pediatrics 1996,98:1138-42.

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