Comparison of Pica Prevalence Between Children and Adolescents with Iron Deficiency and Iron Deficiency Anaemia: A Prospective Cross-Sectional Study

Year 2024, Volume: 34 Issue: 3, 392 - 399, 30.06.2024

Sadiye Sert , Şerife Karaçal Say

https://doi.org/10.54005/geneltip.1454049

Abstract

Background/Aims: The existing literature lacks comprehensive data on the association between the severity of iron deficiency (ID) and pica prevalence in children and adolescents. The aim of this study was to explore the prevalence of pica in apparently healthy children and adolescents, and by comparing its occurrence between those diagnosed with ID and those with IDA.
Methods: This prospective cross-sectional study was conducted at the outpatient paediatric clinic over a period of three months. A total of 504 children and adolescents were enrolled in the study. Participants were categorized into three groups based on primary laboratory findings: Group 1 (healthy), Group 2 (isolated ID), and Group 3 (IDA).
Results: A pica prevalence rate of 5.35% was observed, with a significantly higher occurrence among children suffering from IDA compared to those with ID and their healthy counterparts (p: <0.0001). Moreover, the prevalence was significantly higher in the 12-17.9 years age group (p: 0.01). Female sex and serum ferritin level emerged as the most significant independent predictors associated with pica in our investigation.
Conclusions: Our study demonstrated a higher prevalence of the pica among children suffering from IDA, the most severe form of iron deficiencies, compared with those with isolated ID.

Keywords

adolescent, children, iron deficiency, iron deficiency anaemia, pica

Demir Eksikliği ve Demir Eksikliği Anemisi Olan Çocuklar ve Ergenler Arasındaki Pika Prevalansının Karşılaştırılması: Bir Prospektif Kesitsel Çalışma

Abstract

Arka Plan/Amaçlar: Mevcut literatürde demir eksikliğinin şiddeti (DE) ile çocuk ve ergenlerde pika prevalansı arasındaki ilişkiye dair kapsamlı veriler bulunmamaktadır. Bu çalışmanın amacı görünüşte sağlıklı çocuk ve ergenlerde pika prevalansını araştırmak ve DE tanısı alan kişiler ile DEA tanısı alan kişiler arasındaki görülme sıklığını karşılaştırmaktı.
Yöntemler: Bu prospektif kesitsel çalışma, pediatri polikliniğinde üç ay boyunca gerçekleştirildi. Çalışmaya toplam 504 çocuk ve ergen katılmıştır. Katılımcılar birincil laboratuvar bulgularına göre üç gruba ayrıldı: Grup 1 (sağlıklı), Grup 2 (izole DE) ve Grup 3 (DEA).
Bulgular: %5,35'lik bir pika yaygınlık oranı gözlendi; DEA'lı çocuklar arasında, DE'li çocuklar ve onların sağlıklı akranlarıyla karşılaştırıldığında önemli ölçüde daha yüksek bir görülme sıklığı gözlendi (p: <0,0001). Ayrıca 12-17,9 yaş grubunda prevalans anlamlı olarak daha yüksekti (p:0,01). Araştırmamızda kız cinsiyeti ve serum ferritin düzeyi pika ile ilişkili en önemli bağımsız belirleyiciler olarak ortaya çıktı.
Sonuçlar: Çalışmamız, demir eksikliğinin en şiddetli şekli olan DEA'dan mustarip çocuklarda, izole DE'li çocuklarla karşılaştırıldığında pika prevalansının daha yüksek olduğunu gösterdi.

Keywords

ergen, çocuk, demir eksikliği, demir eksikliği anemisi, pika

References

• AlHarbi HRS, Alharbi KR, Aljudaya MT, Mohammed AM. Prevalence and risk factors of iron deficiency anemia among children; A systematic review. IJMDC 2024; 8(1): 264-271. Leung AKC, Lam JM, Wong AHC, Hon KL, Li X. Iron Deficiency Anemia: An Updated Review. Curr Pediatr Rev 2024; 20(3): 339-356.
• Ozdemir N. Iron deficiency anemia from diagnosis to treatment in children. Turk Pediatri Ars 2015;50(1):11–19.
• Animasahun BA, Itiola AY. Iron deficiency and iron deficiency anaemia in children: physiology, epidemiology, aetiology, clinical effects, laboratory diagnosis and treatment: literature review. J Xiangya Med 2021; 6: 22.
• Beard J. Iron deficiency alters brain development and functioning. J Nutr 2003; 133(5 Suppl 1): 1468S–1472S.
• Shafir T, Angulo-Barroso R, Jing Y, et al. Iron deficiency and infant motor development. Early Hum Dev 2008; 84: 479-485.
• Murray HB, Thomas JJ, Hinz A, Munsch S, Hilbert A. Prevalence in primary school youth of pica and rumination behavior: The understudied feeding disorders. Int J Eat Disord 2018; 51994-998.
• Borgna-Pignatti C, Zanella S. Pica as a manifestation of iron deficiency. Expert Rev Hematol 2016; 9: 1075-1080.
• Abrahams PW. Soils: Their implications to human health. Sci Total Environ 2002: 291: 1–32.
• Ardeshirian KA, Howarth DA. Esperance pica study. Aust Fam Physician 2017; 46: 243-248.
• Young SL. Pica in pregnancy: new ideas about an old condition. Annu Rev Nutr 2010; 30: 403-422.
• Akram S, Khan M A. Pica with Iron Deficiency Anemia in Preschoolers of Central Punjab Pakistan; Tip of The Iceberg. Pak Pediatr J 2023; 47: 16-21.
• Hartmann AS, Poulain T, Vogel M, Hiemisch A, Kiess W, Hilbert A. Prevalence of pica and rumination behaviors in German children aged 7-14 and their associations with feeding, eating, and general psychopathology: a population-based study. Eur Child Adolesc Psychiatry 2018; 27: 1499-1508.
• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA: American Psychiatric Association, 2013.
• De Benoist B, Cogswell M, Egli I, McLean E.Worldwide Prevalence of Anemia 1993-2005: WHO Global Database on Anemia. Geneva: World Health Organization, 2008.
• McDonagh MS, Blazina I, Dana T, Cantor A, Bougatsos C. Screening and routine supplementation for iron deficiency anemia: A systematic review. Pediatrics 2015;135:723-733.
• RoganovicJ, StarinacK. Iron deficiency anemia in children. Current topics in anemia. InTech 2018; 47: 47-71.
• Gupta PM, Perrine CG, Mei Z, Scanlon KS. Iron, Anemia, and Iron Deficiency Anemia among Young Children in the United States. Nutrients 2016; 8(6): 330.
• Korol TG, Khromykh KV, Rudenko HM, Bereznitskiy AV. Scientific reviews. Principles of diagnosis and treatment of iron deficiency anemia in children. Reports of Vinnytsia National Medical University 2021; 25: 510-513.
• Emre F, Oguz O. Prevalence of Anaemia and Iron Deficiency Anaemia among Elementary School Children in Turkey. Annals of Medical Research 2021; 28: 490-495. doi:10.5455/annalsmedres.2020.02.116.
• Pektaş E, Aral YZ, Yenisey Ç. The Prevalence of Anemia and Nutritional Anemia in Primary School Children in the City of Aydın. Meandros Medical Journal 2015; 16: 97-107.
• Güngör O, Albayrak D. Prevalence of iron deficiency and iron deficiency anemia among 7-14 years old children in Samsun. İzmir Dr. Behçet Uz Çocuk Hastanesi Dergisi 2018; 8: 122-126.
• Celep G, Durmaz Z. Iron Deficiency and Iron Deficiency Anemia in Children: A Single-Center Experience. Istanbul Gelisim University Journal of Health Sciences 2021; 13: 16-29.
• World Health Organization. Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks. Geneva, Switzerland: World Health Organization, 2009.
• Balci YI, Karabulut A, Gürse D, Ethem Çövüt I.. Prevalence and risk factors of anemia among adolescents in Denizli, Turkey. Iran J Pediatr 2012;22:77-81.
• Yadav D, Chandra J. Iron deficiency: beyond anemia. Indian J Pediatr 2011; 78: 65-72.
• Güzeloğlu E. Nutritional Anemia Causes in Adolescent Children. Online Turkish Journal of Health Sciences. 2020; 5: 25-32.
• WHO Regional Office for South-East Asia. Prevention of iron deficiency anaemia in adolescents: Role of weekly iron and folic acid supplementation. New Delhi, India: World Health Organization Regional Office for South-East Asia, 2011.
• Ford ND, Bichha RP, Parajuli KR, Paudyal N, Joshi N, Whitehead RD Jr, et al. Factors associated with anaemia among adolescent boys and girls 10-19 years old in Nepal. Matern Child Nutr 2022; 18: e13013.
• Traugott MT, Singh M, Raj DK, Kutalek R. Geophagy in India: a qualitative exploratory study on motivation and perception of female consumers. Trans R Soc Trop Med Hyg 2019; 113: 123-130.
• Sadeghzadeh M, Khoshnevisasl P, Sadeghzadeh S. The relation between pica and iron deficiency in children in Zanjan, Islamic Republic of Iran: a case-control study. East Mediterr Heal J 2017; 23: 404-407.
• El Nemer FM, Alian DM, Salah Eldin M, Khalil HEM. Prevalence of pica among children attending paediatrics clinic at El-Menoufiya University Hospital. Am J BioScience 2014; 2: 147-152.
• Ahmed MA, Al-Nafeesah A, AlEed A, Adam I. Prevalence and associated factors of symptoms of pica among adolescent schoolchildren in northern Sudan: a cross-sectional study. J Eat Disord 2023; 11: 49.
• Al Nasser Y, Muco E, Alsaad AJ. Pica. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2023.
• Miao D, Young SL, Golden CD. A meta-analysis of pica and micronutrient status. Am J Hum Biol 2015; 27: 84-93.
• Najeeb S, Shah S H, Aalia B, et al. Assessment of children presenting with a history of pica for iron deficiency anemia by serum ferritin estimation. Pakistan Journal of Physiology. 2020; 16: 48-51.
• Jafar ZS, Uzair M, Ali M. Anemia in Children Aged 12-59 Months Presenting with a History of Pica. Pak Postgrad Med J. 2021; 33: 117-119.
• Nchito M, Wenzel Geissler P, Mubila L, Friis H, Olsen A. Effects of iron and multimicronutrient supplementation on geophagy: a two-by-two factorial study among Zambian schoolchildren in Lusaka. Trans R Soc Trop Med Hyg 2004; 98: 218-27.
• Parry-Jones B, Parry-Jones WL. Pica: symptom or eating disorder? A historical assessment. Br J Psychiatry 1992; 160: 341-354.
• Rose EA, Porcerelli JH, Neale AV. Pica: common but commonly missed. J Am Board Fam Pract 2000; 13: 353-358.
• Bay A, Dogan M, Bulan K, Kaba S, Demir N, Öner AF. A study on the effects of pica and iron-deficiency anemia on oxidative stress, antioxidant capacity and trace elements. Hum Exp Toxicol 2013; 32: 895903.
• Roy A, Fuentes-Afflick E, Fernald LCH, Young SL. Pica is prevalent and strongly associated with iron deficiency among Hispanic pregnant women living in the United States. Appetite 2018;120:163-170.