Zinc Protoporphyrin and Iron Deficiency Screening Trends and Therapeutic Response in an Urban Pediatric Center Zinc Protoporphyrin and Iron Deficiency Screening

Magge H, Sprinz P, Adams WG, et al. — Mon, 01 Apr 2013 00:00:00 GMT

Importance

Iron deficiency is the most common micronutrient deficiency among children worldwide, with iron-deficiency anemia associated with long-term adverse neurodevelopmental effects.

Objective

To understand the role of zinc protoporphyrin (ZPP) in iron deficiency screening in a low-income pediatric population, as well as to describe the prevalence and trends of abnormal ZPP and the response to iron therapy.

Design

Retrospective longitudinal study of data from electronic medical records collected from January 1, 2002, through December 31, 2010.

Setting

Boston Medical Center primary care center.

Participants

A total of 2612 children with baseline routine screening results for complete blood cell count, lead, and ZPP drawn between ages 8 and 18 months and at follow-up were included. Children with sickle cell disease or lead toxicity were excluded.

Intervention

Documented iron prescription.

Main Outcome Measure

Reduction of baseline abnormal ZPP at follow-up.

Results

Of 2612 children, 48% had an abnormal ZPP level at baseline. Among those with abnormal ZPP (n = 1254), 18% were prescribed iron. Iron prescription was significantly associated with ZPP reduction (odds ratio, 1.5; 95% CI, 1.1 to 2.0) and greater mean change in ZPP (mean difference, −4.4; 95% CI, −7.2 to −1.5). In multivariate analysis, the effect of iron prescription on the reduction of abnormal ZPP was modified by hemoglobin level. Iron prescription was significantly associated with ZPP reduction among those with anemia (odds ratio, 2.4; 95% CI, 1.1 to 5.0). Iron was rarely prescribed in children without anemia; a substantial, but not statistically significant, trend to improvement in those prescribed iron with low-normal hemoglobin was found.

Conclusions and Relevance

Abnormal ZPP was common in this low-income population. Iron prescription was significantly associated with a larger reduction of ZPP. Our data suggest that ZPP may be appropriate for iron deficiency screening; further investigation is warranted to explore the role of ZPP among nonanemic children.

School-Community Partnerships A Cluster-Randomized Trial of an After-School Soccer Program

Madsen K, Thompson H, Adkins A, et al. — Mon, 01 Apr 2013 00:00:00 GMT

Importance

Identifying community-based programs that increase physical activity among diverse youth could yield sustainable tools to reduce obesity and obesity disparities.

Objective

To evaluate the impact of a community-based after-school soccer and youth development program, America SCORES, on students' physical activity, weight status, and fitness.

Design

Cluster-randomized trial. Study measures were collected in the fall (baseline), winter (midpoint), and spring (end point) of the 2009-2010 school year.

Setting

After-school programs in 6 schools within a large urban school district.

Participants

All 4th and 5th grade students in after-school programs at the study schools were eligible.

Intervention

Three schools were randomized to receive the SCORES after-school program, delivered via the train-the-trainer model.

Main Outcome Measures

Change in minutes of after-school moderate-to-vigorous physical activity (MVPA), fitness (maximal oxygen consumption), and body mass index over 1 school year.

Results

Participants (n = 156) were diverse (42% Latino, 32% Asian, and 12% African American) and 76 (49%) had a body mass index at or above the 85th percentile. There were no significant group differences in the change in physical activity, fitness, or weight status among all students. However, among students with a body mass index at or above the 85th percentile, SCORES significantly increased MVPA after school (3.4 min/d; 95% CI, 0.3-6.5) and on Saturdays (18.5 minutes; 95% CI, 3.4-33.6).

Conclusions and Relevance

Existing community-based programs such as SCORES can increase physical activity among low-income youth, particularly those most at risk for weight-related comorbidities. While evaluating existing programs presents special challenges, partnerships between communities, schools, and researchers are an important component of translational research to address obesity.

Trial Registration

clinicaltrials.gov Identifier: NCT01156103

JAMA Pediatrics: Socioeconomic Issues Topic Collection

Zinc Protoporphyrin and Iron Deficiency Screening Trends and Therapeutic Response in an Urban Pediatric Center Zinc Protoporphyrin and Iron Deficiency Screening

School-Community Partnerships A Cluster-Randomized Trial of an After-School Soccer Program