Iron, Infection, and Malnutrition: An Exploration of Childhood Anemia in a Peri-Urban Community in Lima, Peru Public Deposited

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  • Dorsey, Achsah
    • Affiliation: College of Arts and Sciences, Department of Anthropology
  • Anemia remains common worldwide among young children, despite numerous public health interventions and the availability of inexpensive iron supplements. Peru manifests some of the highest rates of anemia in South America, roughly comparable to countries in sub-Saharan Africa, where anemia rates tend to be highest. Several initiatives by the Peruvian Ministry of Health have attempted to reduce levels of anemia, however, national rates of anemia have remained high and even increased in some areas. One potential explanation for persistently high rates of anemia is that they represent an evolutionary adaptation for combatting infectious disease since low levels of iron availability impede the survival and reproduction of pathogens. The Optimal Iron Hypothesis proposes that iron deficiency protects against debilitating levels of infectious disease and that an individual’s optimal iron status is contingent on their particular environmental context. The body must therefore strike a balance between iron withholding and iron availability in order to protect against infection while avoiding compromised immune function. This project expands on existing scholarship by exploring anemia in 102 pre-school aged children living in a community within San Juan de Lurigancho. Analyses from this study establish predictors of childhood anemia and response to iron supplementation, explore the relationship between energetics and immune response, as well as identify the role of intestinal microbiota diversity on recovery from anemia. The associations identified between child growth patterns coupled with maternal perceptions of child body size, household composition, and seasonality with iron status indicate the importance of including caregiver, household, and environmental factors in addition to individual-level variables in studies of childhood anemia. While obesity has been shown to increase inflammation and decrease iron absorption, results from my study complicate this narrative. Analyses show different patterns of response to iron supplementation between children with high and low central adiposity and total body fat, this demonstrates how fat distribution can impact immune function and nutritional status. This work also identifies the intestinal microbiome as an underlying pathway linking nutritional deficiencies and disease ecology through observed differences in gut microbiota and taxa in pre- and post- iron supplementation samples, demonstrating the need to include gut health indicators in medical and nutritional interventions.
Date of publication
Resource type
  • Thompson, Amanda L
  • Sorensen, Mark V
  • Leslie, Paul W
  • Miller, Elizabeth M
  • Bentley, Margaret E
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2020

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