{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T18:25:08Z","timestamp":1773685508694,"version":"3.50.1"},"reference-count":48,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2018,10,11]],"date-time":"2018-10-11T00:00:00Z","timestamp":1539216000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Data on the nutritional situation and prevalence of micronutrient deficiencies in Azerbaijan are scarce, and knowledge about anemia risk factors is needed for national and regional policymakers. A nationally representative cross-sectional survey was conducted to assess the prevalence of micronutrient deficiencies, over- and undernutrition, and to disentangle determinants of anemia in children and women in Azerbaijan. The survey generated estimates of micronutrient deficiency and growth indicators for children aged 0\u201359 months of age (6\u201359 months for blood biomarkers) and non-pregnant women 15\u201349 years of age. Questionnaire data, anthropometric measurements, and blood samples were collected to assess the prevalence of under- and over-nutrition, anemia, iron deficiency, and iron deficiency anemia, in both groups. In children only, vitamin A deficiency and zinc deficiency were also assessed. In women only, folate and vitamin B12 deficiencies and vitamin A insufficiency were assessed. In total, 3926 household interviews were successfully completed with a response rate of 80.6%. In the 1455 children, infant and young child feeding practices were relatively poor overall; the prevalence of wasting and stunting were 3.1% and 18.0%, respectively; and 14.1% of children were overweight or obese. The prevalence of anemia was 24.2% in 6\u201359 months old children, the prevalence of iron deficiency was 15.0% in this age group, and the prevalence of iron deficiency anemia was 6.5%. Vitamin A deficiency was found in 8.0% of children, and zinc deficiency was found in 10.7%. Data from 3089 non-pregnant women 15\u201349 years of age showed that while undernutrition was scarce, 53% were overweight or obese, with increasing prevalence with increasing age. Anemia affected 38.2% of the women, iron deficiency 34.1% and iron deficiency anemia 23.8%. Vitamin A insufficiency was found in 10.5% of women. Folate and vitamin B12 deficiency were somewhat more common, with prevalence rates of 35.0% and 19.7%, respectively. The main risk factors for anemia in children were recent lower respiratory infection, inflammation and iron deficiency. In women, the main risk factors for anemia were iron deficiency and vitamin A insufficiency. Anemia is a public health problem in Azerbaijani children and women, and additional efforts are needed to reduce anemia in both groups.<\/jats:p>","DOI":"10.3390\/nu10101483","type":"journal-article","created":{"date-parts":[[2018,10,12]],"date-time":"2018-10-12T02:58:04Z","timestamp":1539313084000},"page":"1483","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Micronutrient Deficiencies, Over- and Undernutrition, and Their Contribution to Anemia in Azerbaijani Preschool Children and Non-Pregnant Women of Reproductive Age"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4733-0379","authenticated-orcid":false,"given":"James P.","family":"Wirth","sequence":"first","affiliation":[{"name":"GroundWork, 7306 Fl\u00e4sch, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tamerlan","family":"Rajabov","sequence":"additional","affiliation":[{"name":"UNICEF, 1095 Baku, Azerbaijan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicolai","family":"Petry","sequence":"additional","affiliation":[{"name":"GroundWork, 7306 Fl\u00e4sch, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bradley A.","family":"Woodruff","sequence":"additional","affiliation":[{"name":"GroundWork, 7306 Fl\u00e4sch, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nafisa Binte","family":"Shafique","sequence":"additional","affiliation":[{"name":"UNICEF, 1095 Baku, Azerbaijan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rashed","family":"Mustafa","sequence":"additional","affiliation":[{"name":"UNICEF, 1095 Baku, Azerbaijan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2199-6364","authenticated-orcid":false,"given":"Vilma Qahoush","family":"Tyler","sequence":"additional","affiliation":[{"name":"UNICEF Regional Office for Middle East and North Africa, Amman 11821, Jordan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0579-6952","authenticated-orcid":false,"given":"Fabian","family":"Rohner","sequence":"additional","affiliation":[{"name":"GroundWork, 7306 Fl\u00e4sch, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2018,10,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e16","DOI":"10.1016\/S2214-109X(13)70001-9","article-title":"Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995\u20132011: A systematic analysis of population-representative data","volume":"1","author":"Stevens","year":"2013","journal-title":"Lancet Glob. Health"},{"key":"ref_2","unstructured":"WHO (2001). Iron Deficiency Anaemia: Assessment, Prevention, and Control. A Guide for Programme Managers, World Heal Organ."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1182\/blood-2013-06-508325","article-title":"A systematic analysis of global anemia burden from 1990 to 2010","volume":"123","author":"Kassebaum","year":"2014","journal-title":"Blood"},{"key":"ref_4","unstructured":"Allen, L., de Benoist, B., Dary, O., and Hurrell, R. (2006). Guidelines on Food Fortification with Micronutrients, World Health Organization."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/S0140-6736(07)61692-4","article-title":"Maternal and child undernutrition: Consequences for adult health and human capital","volume":"371","author":"Victora","year":"2008","journal-title":"Lancet"},{"key":"ref_6","unstructured":"WHO (2015). Guideline: Optimal Serum and Red Blood Cell Folate Concentrations in Women of Reproductive Age for Prevention of Neural Tube Defects, World Health Organization."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S74","DOI":"10.1177\/15648265080292S111","article-title":"A high prevalence of biochemical evidence of vitamin B12 or folate deficiency does not translate into a comparable prevalence of anemia","volume":"29","author":"Metz","year":"2008","journal-title":"Food Nutr. Bull."},{"key":"ref_8","first-page":"1","article-title":"Effects and safety of periconceptional fotale supplementation for preventing birth defects","volume":"2","author":"Dowswell","year":"2014","journal-title":"Cochrame Database Syst. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Blencowe, H., Cousens, S., Modell, B., and Lawn, J. (2010). Folic acid to reduce neonatal mortality from neural tube disorders. Int. J. Epidemiol., 39.","DOI":"10.1093\/ije\/dyq028"},{"key":"ref_10","unstructured":"UNICEF (2015). Azerbaijan Nutrition Survey, 2013, UNICEF."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3127","DOI":"10.1093\/jn\/134.11.3127","article-title":"Combined measurement of ferritin, soluble transferrin receptor, retinol binding protein, and C-reactive protein by an inexpensive, sensitive, and simple sandwich enzyme-linked immunosorbent assay technique","volume":"134","author":"Erhardt","year":"2004","journal-title":"J. Nutr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.1093\/ajcn\/66.6.1398","article-title":"Field-study screening of blood folate concentrations: Specimen stability and finger-stick sampling","volume":"66","author":"Kelleher","year":"1997","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_13","unstructured":"World Health Organization (2018, May 15). Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity. Available online: http:\/\/www.who.int\/vmnis\/indicators\/haemoglobin.pdf."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"546","DOI":"10.3945\/ajcn.2010.29284","article-title":"Adjusting plasma ferritin concentrations to remove the effects of subclinical inflammation in the assessment of iron deficiency: A meta-analysis","volume":"92","author":"Thurnham","year":"2010","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_15","unstructured":"WHO (2011). Serum Ferritin Concentrations for the Assessment of Iron Status and Iron Deficiency in Populations. Vitamin and Mineral Nutrition Information System, Switzerland."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2052","DOI":"10.1016\/S0140-6736(03)15099-4","article-title":"Effects of subclinical infection on plasma retinol concentrations and assessment of prevalence of vitamin A deficiency: Meta-analysis","volume":"362","author":"Thurnham","year":"2003","journal-title":"Lancet"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1038\/sj.ejcn.1602456","article-title":"Validation of a rapid enzyme immunoassay for the quantitation of retinol-binding protein to assess vitamin A status within populations","volume":"60","author":"Hix","year":"2006","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_18","unstructured":"WHO (2018, May 15). Serum Retinol Concentrations for Determining the Prevalence of Vitamin A Deficiency in Populations. Available online: http:\/\/www.who.int\/vmnis\/indicators\/retinol.pdf."},{"key":"ref_19","unstructured":"Tanumihardjo, S.A. (2018, May 15). Biomarkers of Vitamin A Status, What Do They Mean?. Available online: http:\/\/www.who.int\/nutrition\/publications\/micronutrients\/background_paper2_report_assessment_vitAandIron_status.pdf."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1017\/S0007114507883012","article-title":"Using plasma acute-phase protein concentrations to interpret nutritional biomarkers in apparently healthy HIV-1-seropositive Kenyan adults","volume":"100","author":"Thurnham","year":"2008","journal-title":"Br. J. Nutr."},{"key":"ref_21","unstructured":"IZiNCG Secretariat (2012). Assessing Population Zinc Status with Serum Zinc Concentration, IZiNCG. IZiNCG\u2014Technical Brief."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"S238","DOI":"10.1177\/15648265080292S129","article-title":"Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies","volume":"29","year":"2008","journal-title":"Food Nutr. Bull."},{"key":"ref_23","unstructured":"Group MGRS (2006). WHO Child Growth Standards: Length\/Height-for-Age, Weight-for-Length, Weight-for-Height and Body Mass Index-for-Age: Methods and Development, WHO."},{"key":"ref_24","unstructured":"Shetty, P.S., and James, W.P. (1994). Body mass index. A Measure of Chronic Energy Deficiency in Adults, FAO."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"714","DOI":"10.47102\/annals-acadmedsg.V38N8p714","article-title":"A practical guide for multivariate analysis of dichotomous outcomes","volume":"38","author":"Lee","year":"2009","journal-title":"Ann. Acad. Med. Singap."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"15","DOI":"10.2105\/AJPH.88.1.15","article-title":"Use and misuse of population attributable fractions","volume":"88","author":"Rockhill","year":"1998","journal-title":"Am. J. Public Health"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Petry, N., Olofin, I., Hurrell, R.F., Boy, E., Wirth, J.P., Moursi, M., Angel, M.D., and Rohner, F. (2016). The proportion of anemia associated with iron deficiency in low, medium, and high human development index countries: A systematic analysis of national surveys. Nutrients, 8.","DOI":"10.3390\/nu8110693"},{"key":"ref_28","unstructured":"Food Fortification Initiative (2017, June 07). Country Profile\u2014Azerbaijan. Available online: http:\/\/ffinetwork.org\/country_profiles\/country.php?record=52."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Hurrell, R.F., Reddy, M.B., Burri, J., and Cook, J.D. (2000). An evaluation of EDTA compounds for iron fortification of cereal-based foods. Br. J. Nutr.","DOI":"10.1017\/S0007114500002531"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Wirth, J.P., Petry, N., Tanumihardjo, S.A., Rogers, L.M., McLean, E., Greig, A., Garrett, G.S., Klemm, R.D.W., and Rohner, F. (2017). Vitamin a supplementation programs and country-level evidence of vitamin A deficiency. Nutrients, 9.","DOI":"10.3390\/nu9030190"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Hess, S.Y., Peerson, J.M., King, J.C., and Brown, K.H. (2007). Use of serum zinc concentration as an indicator of population zinc status. Food Nutr. Bull.","DOI":"10.1177\/15648265070283S303"},{"key":"ref_32","unstructured":"IZiNCG (2017, June 08). Countries with Serum Zinc Data. Available online: http:\/\/www.izincg.org\/countries-serum-zinc-data\/."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"S5","DOI":"10.1177\/15648265090301S102","article-title":"Recent advances in knowledge of zinc nutrition and human health","volume":"30","author":"Hess","year":"2009","journal-title":"Food Nutr. Bull."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Bekaert, S., Storozhenko, S., Mehrshahi, P., Bennett, M.J., Lambert, W., Gregory, J.F., Schubert, K., Hugenholtz, J., Van Der Straeten, D., and Hanson, A.D. (2008). Folate biofortification in food plants. Trends Plant Sci., 28\u201335.","DOI":"10.1016\/j.tplants.2007.11.001"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Saini, R.K., Nile, S.H., and Keum, Y.S. (2016). Folates: Chemistry, analysis, occurrence, biofortification and bioavailability. Food Res. Int., 1\u201313.","DOI":"10.1016\/j.foodres.2016.07.013"},{"key":"ref_36","unstructured":"State Statistical Committee (Azerbaijan) (2008). Macro International, Azerbaijan Demographic and Health Survey 2006."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/j.clinbiochem.2017.04.006","article-title":"Effects of preanalytical factors on hemoglobin measurement: A comparison of two HemoCue\u00ae point-of-care analyzers","volume":"50","author":"Whitehead","year":"2017","journal-title":"Clin. Biochem."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Engle-Stone, R., Aaron, G.J., Huang, J., Wirth, J.P., Namaste, S.M., Williams, A.M., Peerson, J.M., Rohner, F., Varadhan, R., and Addo, O.Y. (2017). Predictors of anemia in preschool children: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Am. J. Clin. Nutr., 106.","DOI":"10.3945\/ajcn.116.142323"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Wirth, J.P., Rohner, F., Woodruff, B.A., Chiwile, F., Yankson, H., Koroma, A.S., Russel, F., Sesay, F., Dominguez, E., and Petry, N. (2016). Anemia, Micronutrient Deficiencies, and Malaria in Children and Women in Sierra Leone Prior to the Ebola Outbreak\u2014Findings of a Cross-Sectional Study. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0155031"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1007\/s12098-007-0081-3","article-title":"Modifiable risk factors for acute lower respiratory tract infections","volume":"74","author":"Savitha","year":"2007","journal-title":"Indian J. Pediatr."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s13690-016-0132-1","article-title":"Social, economic and environmental risk factors for acute lower respiratory infections among children under five years of age in Rwanda","volume":"74","author":"Harerimana","year":"2016","journal-title":"Arch. Public Health"},{"key":"ref_42","first-page":"PC01-3","article-title":"Low Hemoglobin Level a Risk Factor for Acute Lower Respiratory Tract Infections (ALRTI) in Children","volume":"8","author":"Hussain","year":"2014","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"110","DOI":"10.3325\/cmj.2013.54.110","article-title":"Risk factors for severe acute lower respiratory infections in children: A systematic review and meta-analysis","volume":"54","author":"Jackson","year":"2013","journal-title":"Croat. Med. J."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"616S","DOI":"10.1093\/jn\/131.2.616S","article-title":"Iron and its relation to immunity and infectious disease","volume":"131","author":"Oppenheimer","year":"2001","journal-title":"J. Nutr."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"4150","DOI":"10.1093\/jn\/133.12.4150","article-title":"Simultaneous weekly supplementation of iron and zinc is associated with lower morbidity due to diarrhea and acute lower respiratory infection in Bangladeshi infants","volume":"133","author":"Baqui","year":"2003","journal-title":"J. Nutr."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1056\/NEJMra041809","article-title":"Anemia of chronic disease","volume":"352","author":"Weiss","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1908","DOI":"10.1056\/NEJMra1404415","article-title":"The \u03b1-Thalassemias","volume":"371","author":"Longo","year":"2014","journal-title":"N. Engl. J. Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"348S","DOI":"10.3945\/ajcn.116.142315","article-title":"Factors associated with inflammation in preschool children and women of reproductive age: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project","volume":"106","author":"Merrill","year":"2017","journal-title":"Am. J. Clin. Nutr."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/10\/10\/1483\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T15:25:02Z","timestamp":1760196302000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/10\/10\/1483"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,10,11]]},"references-count":48,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2018,10]]}},"alternative-id":["nu10101483"],"URL":"https:\/\/doi.org\/10.3390\/nu10101483","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,10,11]]}}}