QUESTIONS TO DETERMINE RISK OF IRON DEFICIENCY ANEMIA IN YOUNG CHILDREN

在市中心的诊所进行了一项横断面研究，在9-30个月大的儿童中进行了常规贫血筛查，作为计划访问的一部分。家长填写了一份调查问卷，并对孩子进行了静脉血全血细胞计数和铁蛋白取样。贫血定义为Hb < 11.0 g/dl。铁缺乏（ID）定义为铁蛋白< 10 mg/l或MCV < 70fl和RDW > 14.5%。儿童被分为四组：缺铁不贫血（ISNA）、缺铁不贫血（ISA）、缺铁不贫血（IDNA）、缺铁贫血（IDA）。问卷包括婴儿饮食、固体食物摄入、饮料摄入和参与WIC计划等15个膳食项目，以及出生史、近期疾病、慢性疾病、贫血史和孕产妇史等14个历史项目。对单个项目、域和选定项目的组合进行分析。结果：282名研究对象中，贫血患病率（35%）、IDNA患病率（7%）和IDA患病率（8%）随年龄变化无显著差异。在个人病史和饮食问题中，母亲贫血史和每天饮用两杯以上果汁确定了IDA儿童的最高比例，分别为50%敏感性（95% CL 16,81）和77%敏感性（54,89）。然而，由于这些问题的特异性分别只有60%（55,65）和22%(17,27)，它们的阳性预测值只有9%（6,13）和8%（4,17）。对IDA敏感度最高的问题领域是饮料摄入，占91%（68,99）和固体食物摄入，占91%（68,99）。然而，特异度分别为14%（10,18）和29%(24,35)，阳性预测值仅为8%和10%。Boutry和Needlman使用的膳食对IDA的敏感性为95%(77,99)，特异性仅为15%（11,19）。CDC推荐的健康和饮食筛查对IDA的敏感性为73%(56,92)，特异性为29%（24,35）。单个问题、问题域和问题域间组对贫血和ID （IDA + IDNA）具有相似的敏感性、特异性和预测值。

A cross-sectional study was conducted in inner-city clinics, in children aged 9-30 months having routine anemia screening as part of a scheduled visit. Parents completed a questionnaire and children had venous blood sampling for complete blood count and ferritin. Anemia was defined as Hb < 11.0 g/dl. Iron deficiency (ID) was defined as ferritin < 10 mg/l or MCV < 70fl and RDW > 14.5%. Children were categorized into one of four groups: iron sufficient not anemic (ISNA), iron sufficient anemic (ISA), iron deficient not anemic (IDNA), iron deficient anemic (IDA). The questionnaire consisted of 15 dietary items in domains of infant diet, intake of solid food, intake of beverages and participation in the WIC program together with 14 historical items in domains of birth history, recent illness, chronic medical conditions, history of anemia and maternal history. Analysis was performed on individual items, domains and combinations of selected items. RESULTS: Of the 282 study subjects, the prevalence of anemia (35%), IDNA (7%) and IDA (8%) did not vary significantly by age. Among individual historical and dietary questions, maternal history of anemia and drinking more than two glasses of juice per day identified the highest proportion of children with IDA, 50% sensitivity (95% CL 16,81) and 77% sensitivity (54,89) respectively. However, because specificities for these questions were only 60% (55,65) and 22% (17,27), respectively, their positive predictive values were only 9% (6,13) and 8% (4,17). Domains of questions with the highest sensitivity for IDA were beverage intake, 91% (68,99) and intake of solid food, 91% (68,99). However, specificities of the domains were 14% (10,18) and 29% (24,35) respectively, yielding positive predictive values of only 8% and 10%. The dietary items used by Boutry and Needlman were 95% (77,99) sensitive but only 15% (11,19) specific for IDA. The CDC recommendations for health and dietary screening were 73% (56,92) sensitive and 29% (24,35) specific for IDA. The individual questions, domains of questions and inter-domain groups of questions had similar sensitivity, specificity and predictive value for anemia and ID (IDA + IDNA).