ABSTRACT OBJECTIVE: This study aimed to describe the prevalence and predictors of childhood anemia in an Amazonian population-based birth cohort study. METHODS: Prevalence of maternal anemia was estimated at delivery (hemoglobin [Hb] concentration < 110 g/L) in women participating in the MINA-Brazil birth cohort study and in their children, examined at ages one, two (Hb < 110 g/L), and five (Hb < 115 g/L). Moreover, ferritin, soluble transferrin receptor, and C-reactive protein concentrations were measured in mothers at delivery and in their 1- and 2-year-old children to estimate the prevalence of iron deficiency and its contribution to anemia, while adjusting for potential confounders by multiple Poisson regression analysis (adjusted relative risk [RRa]). RESULTS: The prevalence 95% confidence interval (CI) of maternal anemia, iron deficiency, and iron-deficiency anemia at delivery were 17.3% (14.0–21.0%), 42.6% (38.0–47.2%), and 8.7% (6.3–11.6)%, respectively (n = 462). At one year of age (n = 646), 42.2% (38.7–45.8%) of the study children were anemic, 38.4% (34.6–42.3%) were iron-deficient, and 26.3 (23.0–29.9) had iron-deficiency anemia. At two years of age (n = 761), these values decreased to 12.8% (10.6–15.2%), 18.1% (15.5–21.1%), and 4.1% (2.8–5.7%), respectively; at five years of age (n = 655), 5.2% (3.6–7.2%) were anemic. Iron deficiency (RRa = 2.19; 95%CI: 1.84–2.60) and consumption of ultra-processed foods (UPF) (RRa = 1.56; 95%CI: 1.14–2.13) were significant contributors to anemia at 1 year, after adjusting for maternal schooling. At 2 years, anemia was significantly associated with maternal anemia at delivery (RRa: 1.67; 95%CI: 1.17–2.39), malaria since birth (2.25; 1.30–3.87), and iron deficiency (2.15; 1.47–3.15), after adjusting for children's age and household wealth index. CONCLUSIONS: Anemia continues to be highly prevalent during pregnancy and early childhood in the Amazon. Public health policies should address iron deficiency, UPF intake, maternal anemia, and malaria to prevent and treat anemia in Amazonian children. OBJECTIVE populationbased population based METHODS hemoglobin Hb [Hb 11 g/L gL g L MINABrazil MINA Brazil g/L, , g/L. . Moreover ferritin receptor Creactive C reactive 2yearold yearold old adjusted RRa. RRa [RRa]) RESULTS 95 CI (CI irondeficiency 173 17 3 17.3 14.0–21.0%, 140210 14.0–21.0% 14 0 21 (14.0–21.0%) 426 42 6 42.6 38.0–47.2%, 380472 38.0–47.2% 38 47 (38.0–47.2%) 87 8 7 8.7 6.3–11.6%, 63116 6.3–11.6 %, (6.3–11.6)% n 462. 462 462) 646, 646 646) 422 42.2 38.7–45.8% 387458 45 (38.7–45.8% anemic 384 4 38.4 34.6–42.3% 346423 34 (34.6–42.3% irondeficient, irondeficient deficient, deficient iron-deficient 263 26 26. 23.0–29.9 230299 23 29 9 (23.0–29.9 761, 761 761) 128 12 12.8 10.6–15.2%, 106152 10.6–15.2% 10 15 (10.6–15.2%) 181 18 18.1 15.5–21.1%, 155211 15.5–21.1% 5 (15.5–21.1%) 41 4.1 2.8–5.7%, 2857 2.8–5.7% (2.8–5.7%) 655, 655 655) 52 5.2 3.6–7.2% 3672 (3.6–7.2% 2.19 219 19 95%CI 95CI 1.84–2.60 184260 84 60 ultraprocessed ultra processed (UPF 1.56 156 56 1.14–2.13 114213 13 schooling 1.67 167 67 1.17–2.39, 117239 1.17–2.39 39 1.17–2.39) 2.25 225 25 (2.25 1.30–3.87, 130387 1.30–3.87 30 1.30–3.87) 2.15 215 (2.15 1.47–3.15, 147315 1.47–3.15 1.47–3.15) childrens s index CONCLUSIONS Amazon intake [RRa] 17. 14021 14.0–21.0 (14.0–21.0% 42. 38047 38.0–47.2 (38.0–47.2% 8. 6.3–11.6% 6311 6.3–11. % (6.3–11.6) 46 64 38.7–45.8 38745 (38.7–45.8 38. 34.6–42.3 34642 (34.6–42.3 23.0–29. 23029 (23.0–29. 76 12. 10615 10.6–15.2 (10.6–15.2% 18. 15521 15.5–21.1 (15.5–21.1% 4. 285 2.8–5.7 (2.8–5.7% 65 5. 3.6–7.2 367 (3.6–7.2 2.1 1.84–2.6 18426 1.5 1.14–2.1 11421 1.6 16 11723 1.17–2.3 2.2 22 (2.2 13038 1.30–3.8 (2.1 14731 1.47–3.1 [RRa 1402 14.0–21. (14.0–21.0 3804 38.0–47. (38.0–47.2 631 6.3–11 (6.3–11.6 38.7–45. 3874 (38.7–45. 34.6–42. 3464 (34.6–42. 23.0–29 2302 (23.0–29 1061 10.6–15. (10.6–15.2 1552 15.5–21. (15.5–21.1 28 2.8–5. (2.8–5.7 3.6–7. 36 (3.6–7. 2. 1.84–2. 1842 1. 1.14–2. 1142 1172 1.17–2. (2. 1303 1.30–3. 1473 1.47–3. 140 14.0–21 (14.0–21. 380 38.0–47 (38.0–47. 63 6.3–1 (6.3–11. 38.7–45 387 (38.7–45 34.6–42 346 (34.6–42 23.0–2 230 (23.0–2 106 10.6–15 (10.6–15. 155 15.5–21 (15.5–21. 2.8–5 (2.8–5. 3.6–7 (3.6–7 1.84–2 184 1.14–2 114 117 1.17–2 (2 130 1.30–3 147 1.47–3 14.0–2 (14.0–21 38.0–4 (38.0–47 6.3– (6.3–11 38.7–4 (38.7–4 34.6–4 (34.6–4 23.0– (23.0– 10.6–1 (10.6–15 15.5–2 (15.5–21 2.8– (2.8–5 3.6– (3.6– 1.84– 1.14– 1.17– ( 1.30– 1.47– 14.0– (14.0–2 38.0– (38.0–4 6.3 (6.3–1 38.7– (38.7– 34.6– (34.6– 23.0 (23.0 10.6– (10.6–1 15.5– (15.5–2 2.8 (2.8– 3.6 (3.6 1.84 1.14 1.17 1.30 1.47 14.0 (14.0– 38.0 (38.0– 6. (6.3– 38.7 (38.7 34.6 (34.6 23. (23. 10.6 (10.6– 15.5 (15.5– (2.8 3. (3. 1.8 1.1 1.3 1.4 14. (14.0 (38.0 (6.3 (38. 34. (34. (23 10. (10.6 15. (15.5 (3 (14. (6. (38 (34 (10. (15. (14 (6 (10 (15 (1
RESUMO OBJETIVO: O objetivo deste estudo foi descrever a prevalência e os preditores de anemia na infância em um estudo de coorte de nascimentos de base populacional amazônica. MÉTODOS: Estimou-se a prevalência de anemia materna no parto (concentração de hemoglobina [Hb] < 110 g/L) em mulheres participantes do estudo de coorte de nascimentos MINA-Brasil e em seus filhos, examinados nas idades um, dois (Hb < 110 g/L) e cinco anos (Hb < 115 g/L). Além disso, as concentrações de ferritina, receptor solúvel de transferrina e proteína C reativa foram medidas em mães no parto e em seus filhos de 1 e 2 anos de idade para estimar a prevalência de deficiência de ferro e sua contribuição para anemia, ajustando para potenciais fatores de confusão por análise de regressão múltipla de Poisson (risco relativo ajustado [RRa]). RESULTADOS: As prevalências com intervalo de confiança (IC) de 95% de anemia materna, deficiência de ferro e anemia ferropriva no parto foram de 17,3% (14,0–21,0%), 42,6% (38,0–47,2%) e 8,7% (6,3–11,6%), respectivamente (n = 462). No primeiro ano de idade (n = 646), 42,2% (38,7–45,8%) das crianças estudadas eram anêmicas, 38,4% (34,6–42,3%) eram deficientes em ferro e 26,3 (23,0–29,9%) tinham anemia ferropriva. Aos dois anos de idade (n = 761), esses valores diminuíram para 12,8% (10,6–15,2%), 18,1% (15,5–21,1%) e 4,1% (2,8–5,7%), respectivamente; aos cinco anos de idade (n = 655), 5,2% (3,6–7,2%) eram anêmicos. A deficiência de ferro (RRa = 2,19, IC95%: 1,84–2,60) e consumo de alimentos ultraprocessados (AUP) (RRa = 1,56, IC95%: 1,14–2,13) foram contribuintes significantes para anemia no 1° ano de idade, após ajuste para escolaridade materna. Aos 2 anos, a anemia associou-se significativamente à anemia materna no parto (RRa = 1,67; IC95%: 1,17–2,39), malária desde o nascimento (2,25; 1,30–3,87) e deficiência de ferro (2,15; 1,47–3,15), após ajuste para idade das crianças e índice de riqueza familiar. CONCLUSÕES: A anemia continua sendo altamente prevalente durante a gravidez e a primeira infância na Amazônia. Políticas públicas de saúde devem abordar a deficiência de ferro, o consumo de AUP, a anemia materna e a malária para prevenir e tratar a anemia em crianças amazônicas. OBJETIVO amazônica MÉTODOS Estimouse Estimou se concentração Hb [Hb 11 g/L gL g L MINABrasil MINA Brasil g/L. . disso ferritina risco RRa. RRa [RRa]) RESULTADOS IC (IC 95 173 17 3 17,3 14,0–21,0%, 140210 14,0–21,0% , 14 0 21 (14,0–21,0%) 426 42 6 42,6 38,0–47,2% 380472 38 47 (38,0–47,2% 87 8 7 8,7 6,3–11,6%, 63116 6,3–11,6% (6,3–11,6%) n 462. 462 462) 646, 646 646) 422 42,2 38,7–45,8% 387458 45 (38,7–45,8% anêmicas 384 4 38,4 34,6–42,3% 346423 34 (34,6–42,3% 263 26 26, 23,0–29,9% 230299 23 29 9 (23,0–29,9% 761, 761 761) 128 12 12,8 10,6–15,2%, 106152 10,6–15,2% 10 15 (10,6–15,2%) 181 18 18,1 15,5–21,1% 155211 5 (15,5–21,1% 41 4,1 2,8–5,7%, 2857 2,8–5,7% (2,8–5,7%) 655, 655 655) 52 5,2 3,6–7,2% 3672 (3,6–7,2% anêmicos 219 19 2,19 IC95% IC95 1,84–2,60 184260 84 60 AUP (AUP 156 56 1,56 1,14–2,13 114213 13 associouse associou 1,67 167 67 1,17–2,39, 117239 1,17–2,39 39 1,17–2,39) 2,25 225 25 (2,25 1,30–3,87 130387 30 2,15 215 (2,15 1,47–3,15, 147315 1,47–3,15 1,47–3,15) familiar CONCLUSÕES Amazônia amazônicas [RRa] 17, 14021 14,0–21,0 (14,0–21,0% 42, 38,0–47,2 38047 (38,0–47,2 8, 6311 6,3–11,6 (6,3–11,6% 46 64 38,7–45,8 38745 (38,7–45,8 38, 34,6–42,3 34642 (34,6–42,3 23,0–29,9 23029 (23,0–29,9 76 12, 10615 10,6–15,2 (10,6–15,2% 18, 15,5–21,1 15521 (15,5–21,1 4, 285 2,8–5,7 (2,8–5,7% 65 5, 3,6–7,2 367 (3,6–7,2 2,1 IC9 1,84–2,6 18426 1,5 1,14–2,1 11421 1,6 16 11723 1,17–2,3 2,2 22 (2,2 1,30–3,8 13038 (2,1 14731 1,47–3,1 [RRa 1402 14,0–21, (14,0–21,0 38,0–47, 3804 (38,0–47, 631 6,3–11, (6,3–11,6 38,7–45, 3874 (38,7–45, 34,6–42, 3464 (34,6–42, 23,0–29, 2302 (23,0–29, 1061 10,6–15, (10,6–15,2 15,5–21, 1552 (15,5–21, 28 2,8–5, (2,8–5,7 3,6–7, 36 (3,6–7, 2, 1,84–2, 1842 1, 1,14–2, 1142 1172 1,17–2, (2, 1,30–3, 1303 1473 1,47–3, 140 14,0–21 (14,0–21, 38,0–47 380 (38,0–47 63 6,3–11 (6,3–11, 38,7–45 387 (38,7–45 34,6–42 346 (34,6–42 23,0–29 230 (23,0–29 106 10,6–15 (10,6–15, 15,5–21 155 (15,5–21 2,8–5 (2,8–5, 3,6–7 (3,6–7 1,84–2 184 1,14–2 114 117 1,17–2 (2 1,30–3 130 147 1,47–3 14,0–2 (14,0–21 38,0–4 (38,0–4 6,3–1 (6,3–11 38,7–4 (38,7–4 34,6–4 (34,6–4 23,0–2 (23,0–2 10,6–1 (10,6–15 15,5–2 (15,5–2 2,8– (2,8–5 3,6– (3,6– 1,84– 1,14– 1,17– ( 1,30– 1,47– 14,0– (14,0–2 38,0– (38,0– 6,3– (6,3–1 38,7– (38,7– 34,6– (34,6– 23,0– (23,0– 10,6– (10,6–1 15,5– (15,5– 2,8 (2,8– 3,6 (3,6 1,84 1,14 1,17 1,30 1,47 14,0 (14,0– 38,0 (38,0 6,3 (6,3– 38,7 (38,7 34,6 (34,6 23,0 (23,0 10,6 (10,6– 15,5 (15,5 (2,8 3, (3, 1,8 1,1 1,3 1,4 14, (14,0 (38, 6, (6,3 34, (34, 23, (23, 10, (10,6 15, (15, (3 (14, (38 (6, (34 (23 (10, (15 (14 (6 (10 (1
