{
  "abstract": "Introduction The WHO cut-offs to define anaemia among children (haemoglobin, Hb <105 g/L in 6–23 months and <110 g/L in 24–59 months) are based on the distribution of Hb concentrations in a healthy population. Our objective was to identify Hb values that best discriminate functional outcomes among children aged 6–30 months.Methods We used previously compiled datasets from an individual participant data meta-analysis of effects of small quantity lipid-based nutrient supplements. Participants were eligible for this pooled analysis if they had Hb measured at 6–30 months and data on at least one functional outcome of interest, which included physical activity and sleep patterns, and language, socioemotional and motor development. We stratified the datasets by child age in 3-month intervals and analysed associations of Hb with both concurrent and subsequently measured (longitudinal) outcomes. If Hb significantly discriminated the 25th, 50th or 75th percentile of the outcome based on the pooled area under the receiver operating characteristic curve (AUC), we identified the Hb value with the highest concordance probability as the best discriminatory threshold.Results 11 datasets from 8 countries including 27 626 children were analysed. Hb significantly discriminated 21 of 47 concurrent and 11 of 32 longitudinal Hb-outcome associations. Best Hb discriminatory thresholds ranged from 102 to 111 g/L for concurrent physical activity outcomes, 103–116 g/L for concurrent developmental outcomes, and 109–117 g/L for longitudinal developmental outcomes. The I 2 for the pooled AUC analysis indicated generally low to moderate heterogeneity across studies.Conclusions The current WHO cut-offs to define anaemia among children are in the middle to upper range of Hb values that best discriminate concurrent physical activity and development, and are in the lower range of values that best discriminate subsequent child development. Along with other types of evidence, this study provides additional evidence to inform Hb cut-offs to define anaemia among young children.",
  "authors": [
    {
      "affiliations": [
        "Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, California, USA"
      ],
      "name": "Elizabeth L Prado"
    },
    {
      "affiliations": [
        "Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA"
      ],
      "name": "Leila M Larson"
    },
    {
      "affiliations": [
        "Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, California, USA"
      ],
      "name": "Charles D Arnold"
    },
    {
      "affiliations": [
        "Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, California, USA"
      ],
      "name": "K Ryan Wessells"
    },
    {
      "affiliations": [
        "Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK",
        "Oxford Clinical Research Unit Indonesia, Central Jakarta, Indonesia"
      ],
      "name": "Anuraj H Shankar"
    },
    {
      "affiliations": [
        "Department of Nutrition and Food Science, University of Ghana, Accra, Ghana"
      ],
      "name": "Seth Adu-Afarwuah"
    },
    {
      "affiliations": [
        "Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA"
      ],
      "name": "Benjamin F Arnold"
    },
    {
      "affiliations": [
        "Center for Child, Adolescent and Maternal Health Research, Tampere University Faculty of Medicine and Health Technology, Tampere, Finland",
        "Department of Paediatrics, Tampere University Hospital, Tampere, Finland"
      ],
      "name": "Per Ashorn"
    },
    {
      "affiliations": [
        "Center for Child, Adolescent and Maternal Health Research, Tampere University Faculty of Medicine and Health Technology, Tampere, Finland"
      ],
      "name": "Ulla Ashorn"
    },
    {
      "affiliations": [
        "Nutrition, Diets, and Health Unit, International Food Policy Research Institute, Washington, District of Columbia, USA"
      ],
      "name": "Elodie Becquey"
    },
    {
      "affiliations": [
        "Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, California, USA",
        "Helen Keller International, New York, New York, USA"
      ],
      "name": "Kenneth H Brown"
    },
    {
      "affiliations": [
        "Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK"
      ],
      "name": "Jaya Chandna"
    },
    {
      "affiliations": [
        "Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe"
      ],
      "name": "Bernard Chasekwa"
    },
    {
      "affiliations": [
        "Center for Child, Adolescent and Maternal Health Research, Tampere University Faculty of Medicine and Health Technology, Tampere, Finland"
      ],
      "name": "Yue-Mei Fan"
    },
    {
      "affiliations": [
        "Development Research Group, World Bank, Washington, District of Columbia, USA"
      ],
      "name": "Emanuela Galasso"
    },
    {
      "affiliations": [
        "Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, California, USA"
      ],
      "name": "Sonja Y Hess"
    },
    {
      "affiliations": [
        "Nutrition, Diets, and Health Unit, International Food Policy Research Institute, Washington, District of Columbia, USA"
      ],
      "name": "Lieven Huybregts"
    },
    {
      "affiliations": [
        "School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia"
      ],
      "name": "Kaniz Jannat"
    },
    {
      "affiliations": [
        "Departments of Pediatrics and Internal Medicine and College of Population Health, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA"
      ],
      "name": "Elizabeth Yakes Jimenez"
    },
    {
      "affiliations": [
        "Department of Nutrition and Food Science, University of Ghana, Accra, Ghana"
      ],
      "name": "Anna Lartey"
    },
    {
      "affiliations": [
        "Montpellier Interdisciplinary Center on Sustainable Agri food systems, French National Research Institute for Sustainable Development, Marseille, France"
      ],
      "name": "Agnes Le Port"
    },
    {
      "affiliations": [
        "Nutrition, Diets, and Health Unit, International Food Policy Research Institute, Washington, District of Columbia, USA"
      ],
      "name": "Jef L Leroy"
    },
    {
      "affiliations": [
        "Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA"
      ],
      "name": "Stephen P Luby"
    },
    {
      "affiliations": [
        "Department of Public Health, School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi"
      ],
      "name": "Kenneth Maleta"
    },
    {
      "affiliations": [
        "Department of Public Health, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi"
      ],
      "name": "Andrew Matchado"
    },
    {
      "affiliations": [
        "Department of Medical Biology and Nutrition, University of California Berkeley, Berkeley, California, USA"
      ],
      "name": "Susana L Matias"
    },
    {
      "affiliations": [
        "Center for Non-Communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Bangladesh"
      ],
      "name": "Malay Kanti Mridha"
    },
    {
      "affiliations": [
        "Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe"
      ],
      "name": "Kuda Mutasa"
    },
    {
      "affiliations": [
        "Mathematica Inc, Washington, Washington, USA"
      ],
      "name": "Clair Null"
    },
    {
      "affiliations": [
        "Department of Nutritional Sciences, Oklahoma State University, Stillwater, Oklahoma, USA"
      ],
      "name": "Harriet Okronipa"
    },
    {
      "affiliations": [
        "Health Sciences Research Institute, Bobo-Dioulasso, Burkina Faso"
      ],
      "name": "Jean Bosco Ouédraogo"
    },
    {
      "affiliations": [
        "Tufts University School of Engineering, Medford, Massachusetts, USA"
      ],
      "name": "Amy Pickering"
    },
    {
      "affiliations": [
        "Department of Public Health, School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi"
      ],
      "name": "John Phuka"
    },
    {
      "affiliations": [
        "Research Unit of Population Health, University of Oulu, Oulu, Finland"
      ],
      "name": "Anna Pulakka"
    },
    {
      "affiliations": [
        "Centre Médico-Educatif \"Les Orchidées Blanches”, Antananarivo, Madagascar"
      ],
      "name": "Lisy Ratsifandrihamanana"
    },
    {
      "affiliations": [
        "Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, California, USA"
      ],
      "name": "Christine P Stewart"
    },
    {
      "affiliations": [
        "Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh"
      ],
      "name": "Fahmida Tofail"
    },
    {
      "affiliations": [
        "Department of Biostatistics, Epidemiology and Environmental Health, University of Nevada Reno School of Public Health, Reno, Nevada, USA"
      ],
      "name": "Ann M Weber"
    },
    {
      "affiliations": [
        "Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, California, USA"
      ],
      "name": "Kathryn G Dewey"
    }
  ],
  "title": "Haemoglobin concentration thresholds that discriminate functional outcomes among children aged 6–30 months in eight countries: a pooled analysis of individual participant data",
  "uid": "212a98d8-adbe-5950-af41-d080ccaed3f9"
}