Multifaceted determinants of micronutrient status in early childhood in Iran : National food and nutrition surveillance.

Purpose: This study examined the status and determinants of key micronutrients among 24-60 month children in underprivileged provinces of Iran, highlighting ongoing challenges despite intervention efforts.

Methods: This study analyzed data from the National Food and Nutrition Surveillance program. A multistage cluster sampling method was used, recruiting 280 children per province from Khuzestan, Kerman, Ilam, Bushehr, Hormozgan, Kohgiluyeh va Boyerahmad, Sistan va Baluchestan and South Khorasan. Demographic, dietary, and anthropometric data were collected, and micronutrient status was assessed through hemoglobin, serum ferritin, zinc, retinol and 25-hydroxycalciferol assays.

Results: This study included 2,247 children (42.2 ± 0.3 months). About 40% of children had low dietary diversity, and 48.4% were from low socioeconomic status (SES) families. Anemia was found in 24% of the children. Vitamin D and A deficiency affected 74%, and 22.3% of children, respectively. Notably, 39.1% had multiple micronutrient deficiencies. Father's occupation (odds ratio [OR] (95% confidence interval [CI]; freelance vs. employed: 1.86 (1.13, 3.06), worker vs. employed: 2.3 (1.43, 3.69)) and SES (middle vs. high: 2.15 (1.09, 4.2)) were significant predictors of anemia. Urban living and higher paternal education were protective against low ferritin. Children in lower SES categories and those with poor vitamin D status were more likely to have iron (1.53 (1.12, 2.09), p = 0.007) and zinc deficiencies (2.19 (1.46, 3.29) p < 0.001). Vitamin A and D statuses were mainly influenced by SES, food security, and supplement intake, respectively.

Conclusion: Our findings revealed high prevalence of micronutrient deficiencies among 24-60 month children residing in eight underprivileged provinces of Iran. Parental education, household SES and food security were the main determinants of micronutrient deficiencies among the studied children. Improvement of the households' food access through betterment of economic condition seems inevitable which in turn necessitates an inter-sectorial collaboration.