Case-control Study On Influencing Factors Of Elderly Women Anemia In Poor Rural Area Of Southwest And Northwest Of China

ObjectivesGain the basic diet data of health station and diet intake in poverty-stricken rural elderly women of China during the diet changing period,find the influencing factors of elderly anemia especially micronutrients intake and the influencing intensity;Supply scientific evidence for making feasible interventional measures to improve the health status and then decrease the prevalence of rural elderly anemia.Object and MethodCase-control study at ratio of 1 anemic to 1 non-anemic subject was undertaken.Referring to 2002 nutritional and health survey of China,50-75 years old menopausal women in Huangling of Shanxi province,a northwest region,and in Bama of Guangxi Chuang municipality,a southwest region,were selected as subjects.After general health station filtration and hemoglobin(Hb) test,120 women with Hb of 95 g/L-125g/L were randomly selected into case group,120 women with Hb>135g/L,1:1 matched with cases by age(age fluctuation was not more than 2 years) were selected into control group.A written informed consent needed for all the subjects.Questionnaire survey for general station and dietary, Anthropometric indices measurement and blood index test were conducted.SAS 8.2 was used for Statistic analysis.ResultsPart one:comparison between case and control of Huangling,Shanxi1.1 General stations comparison:hemoglobin,annual income,educational level of case was significantly lower than that of control,while food scarcity experience was significantly higher in case than that in control;Mono-factor conditioned Logistic regression analysis showed that annual income(OR=0.4,95%CI:0.2-0.8),educational level(OR=0.5,95%CI: 0.3-1.1),and physical activity time(OR=0.6,95%CI:0.3-1.1) were protective factors of anemia,while food scarcity experience(OR=2.1,95%CI:1.2-3.9) was risk factors of anemia; annual income and food scarcity experience also entered into poly-factor conditioned logistic regression equation,and their OR(95%CI) was 0.9(0.4-2.1),1.7(0.8-3.9),respectively. 1.2 Anthropometric indices comparison:the waist circumference and BMI of case was significantly lower than that of control;Mono-factor conditioned logistic regression analysis showed that BMI was protective factor with OR=0.6,95%CI:0.4-1.1,but it didn't enter into poly-factor conditioned logistic regression equation.1.3 Dietary qualities comparison:staple food(wheaten food,other grain and yam) in case was significantly lower than that in control,there was no significant difference in DBI_LBS, proportion of food source for energy,protein and iron between case and control.Mono-factor and poly-factor conditioned logistic regression analysis showed that staple food was protective factor of anemia,which OR(95%CI) was 0.6(0.32-0.98),0.4(0.2-0.8), respectively.1.4 Dietary nutrients comparison:no significant difference was seen in the energy,protein, carbohydrate and fat between case and control,vitamin C intake in case was significantly lower than that in control(P=0.03),but no nutrients entered into mono-factor or poly-factor conditioned logistic regression equation.1.5 Blood index comparison:blood index such as Fer,TF,TP,ALB,VitB₁₂ of case were significantly lower than that of control,but ESR in case was significant higher than that in control.Mono-factor conditioned logistic regression analysis showed that ALB,TP,Fer,TF,VitB₁₂ were protective factors of anemia,which OR(95%CI) was 0.3(0.2-0.5), 0.3(0.2-0.6),0.5(0.3-0.9),0.4(0.3-0.8),0.06(0.03-0.1),respectively.Fer,TF,VitB₁₂ entered into poly-factor conditioned logistic regression equation,which OR(95%CI) was 0.2(0.1-0.5), 0.2(0.1-0.5),0.06(0.03-0.1),respectively.Part two:results comparison between case and control of Bama2.1 General stations comparison:hemoglobin of case was significantly lower than that of control by T-test,there was no significantly difference of all the variables about general stations such as annual income,educational level,food scarcity experience and physical activity time between two groups,and these variables didn't enter into mono-factor and poly-factor conditioned logistic regression equation.2.2 Anthropometric indices comparison:weight,waist circumference,BMI of case were significantly lower than that of control;Mono-factor conditioned logistic regression analysis showed that BMI was protective factor with 0.7(0.4-1.0) as OR(95%CI),but it didn't enter into poly-factor conditioned logistic regression equation. 2.3 Dietary qualities comparison:staple food and animal food in case were significantly lower than that in control,red meat,poultry and eggs in sub-group of animal food in case were significantly lower than that in control,significant difference was seen in DBILBS and DBI of animal food;animal food proportion for energy in case was significantly lower than that in control,while pour-energy food proportion for energy in case was significantly higher than that in control;animal food proportion for protein and iron were both significantly lower than that in control;DBILBS and animal food entered into mono-factor conditioned logistic regression equation with 2.4(1.4-4.2) and 0.4(0.2-0.7) as OR(95%CI);poly-factor conditioned logistic regression analysis showed that DBILBS was a risk factor of anemia, which OR(95%CI) was 2.2(1.2-4.2).2.4 Comparison of Dietary nutrients intake:energy,protein,carbohydrate,vitamin A and vitamin B₂ intake of case were significantly lower than that of control;mono-factor conditioned logistic regression analysis showed that energy,protein and vitamin A were protective factors of anemia with 0.6(0.3-1.0),0.6(0.3-1.0),0.2(0.1-0.4) as OR(95%CI), respectively;vitamin A entered into poly-factor conditioned logistic regression equation with 0.2(0.1-0.4) as OR(95%CI).2.5 Blood index comparison:blood index such as SI,Fer,ALB,TF,TS in case were significantly lower than that in control,while ESR in case were significantly higher than that in control;Mono-factor conditioned logistic regression analysis showed that SI,Fer,TF,TS were protective factors of anemia with 0.4(0.2-0.7),0.5(0.3-0.9),0.5(0.3-0.9),0.5(0.3-1.0) as OR(95%CI),respectively;Fer and TF entered into poly-factor conditioned logistic regression equation with 0.4(0.2-0.8) and 0.4(0.2-0.7) as OR(95%CI),respectively.ConclusionIt was meaningful and feasible for elderly women lived in Huangling as representation of northwest of China to improve anemia by increasing income,improving dietary quality, adjusting dietary structure by adding staple food and other food rich in vitamin B₁₂ such as meat,fish,poultry,eggs and so on;while for elderly women lived in Bama as representation of southwest of China,it was significant and realizable to improve dietary quality and adjusting dietary structure by adding animal food and other food rich in vitamin A just as food above-mentioned which were also rich in vitamin B₁₂.