Introduction: The high rate of malnutrition in young children remains a serious public health issue. Intervention strategies aimed to rectify this situation have succeeded in reducing anaemia, with levels falling to 28.5%. Even so, anaemia levels are still unacceptably high, especially among infants aged 6 to 24 months. Goal: The aim of this survey was to investigate the prevalence of anaemia and iron and folate deficiencies that may contribute to the relatively high rates of anaemia among children aged 6 to 36 months. Subjects and methods: This study involved 243 apparently healthy children (122 boys, 121 girls) from Ulaanbaatar city and Bulgan, Bayankhongor, Dornod and Khovd aimags aged 6 to 36 months with no evidence of infection within the previous 7 days. Ethical approval of the study was obtained from the Medical Ethics Committee of the Mongolian Ministry of Health. Written informed consents were obtained from the guardians of each child.
Morning, non-fasting venipuncture blood samples were used for the determination of the levels of hemoglobin by the hemoglobinometer, of ferritin by the microparticle enzyme immunoassays technology and of folate by the microtiter technique.
The statistical analysis of test results was carried out using SPSS program, with a p-value <0.05 indicating statistical significance. Results: The mean hemoglobin and ferritin concentrations were the highest in the oldest children (i.e., 24 to 36 months). The mean values for hemoglobin were higher in the participants from Ulaanbaatar, whereas the ferritin levels were higher in their counterparts from the rural settings.
Overall, 24% of the children were anaemic. Anaemia prevalence was greater among the children in the rural area than in Ulaanbaatar. The prevalence of iron deficiency anaemia was 15%, and unlike anaemia, was independent of setting. The oldest children aged 24 to 36 months had the lowest prevalence of iron deficiency anaemia in both Ulaanbaatar and the rural area.
The mean serum folate concentration was 19.9 nmol/L. The concentrations decreased with age in both settings, although the mean values in Ulaanbaatar were significantly higher for each age group than those for the rural settings. Only 4% of the children had folate deficiency. None of the participants in Ulaanbaatar had low serum folate concentrations. In the rural settings, the oldest children had the highest prevalence of folate deficiency. Conclusion The prevalence of anaemia and iron deficiency anaemia is high among children aged 6 to 36 months. This finding emphasizes the necessity for programs that supply young children and their mothers with micronutrients such as iron and folate.

Background: The prevalence of rickets is high among Mongolian children. The disease can be prevented by sufficient intake of vitamin D. Vitamin D is a fat-soluble vitamin that is naturally present in very few foods, and is also produced endogenously when ultraviolet rays from sunlight strike the skin and trigger vitamin D synthesis. Serum concentration of 25(OH)D is the best indicator of vitamin D status. The aim of this study was to determine the concentrations of 25(OH)D in serum samples of small children and evaluate their vitamin D status. Materials and Methods: The concentrations of 25(OH)D were determined in serum samples of 98 children (54 male and 44 female) 6-36 months of age using a 2-step radioimmuno assay procedure. Vitamin D defciency was defned as 25(OH)D < 25nmol/L. Results: The mean serum 25(OH)D concentration was 29.00 nmol/L with no statistically signifcant differences between boys and girls, age groups and children from rural and urban areas. The vitamin D defciency among the surveyed children was 61.2%. The defciency was higher among children from Ulaanbaatar city (65.7% vs 51.9% in rural areas) and in boys (66.7% vs 55.8% in girls). Conclusion: The high level of vitamin D deficiency indicates that there is a need to promote the expansion of the coverage of vitamin D supplements among young children.

Background:The prevalence of rickets is high among Mongolian children. The disease can be prevented by sufficient intake of vitamin D. Vitamin D is a fat-soluble vitamin that is naturally present in very few foods, and is also produced endogenously when ultraviolet rays from sunlight strike the skin and trigger vitamin D synthesis. Serum concentration of 25(OH)D is the best indicator of vitamin D status. The aim of this study was to determine the concentrations of 25(OH)D in serum samples of small children and evaluate their vitamin D status.Materials and Methods:The concentrations of 25(OH)D were determined in serum samples of 98 children (54 male and 44 female) 6-36 months of age using a 2-step radioimmuno assay procedure. Vitamin D defciency was defned as 25(OH)D < 25nmol/L.Results:The mean serum 25(OH)D concentration was 29.00 nmol/L with no statistically signifcant differences between boys and girls, age groups and children from rural and urban areas. The vitamin D defciency among the surveyed children was 61.2%. The defciency was higher among children from Ulaanbaatar city (65.7% vs 51.9% in rural areas) and in boys (66.7% vs 55.8% in girls).Conclusion:The high level of vitamin D deficiency indicates that there is a need to promote the expansion of the coverage of vitamin D supplements among young children.

Background: Selenium (Se) is a trace element important for health. Its defciency has adverse effects on reproduction, immunocompetence and cardiovascular status. There is growing evidence that higher Se intakes are associated with reduced cancer risk. To date, there have been no studies conducted on the Se status of Mongolian children. Materials and Methods Non-fasting morning blood samples were collected from 240 children (122 male and 118 female) 6-36 months of age from the capital city of Mongolia and four provinces located in the south, north, east and west of the country. Inclusion criteria were apparently healthy children with no evidence of infection within the previous 7 days. The serum concentrations of Se were determined using graphite furnace atomic absorption spectrometry. Results: The mean serum Se concentration was 0.79 µmol/L. The indicator was higher for children in the rural provinces compared to those who lived in the capital city (0.81 µmol/L vs. 0.76 µmol/L, p=0.029). There was no statistically signifcant difference in the levels of Se detected between boys and girls (0.79 µmol/Lvs. 0.78 µmol/L, p=0.551). The serum concentration of Se increased with age (0.73µmol/L in the 6-11.9 months age group, 0.79 µmol/L in children aged 12-23.9 months and 0.82 µmol/L in 24-36-month-old participants). The prevalence of low serum Se in the surveyed population (<0.82 μmol/L) was 55.8%. The Se defciency tends to decrease with age (63.8% in the 6-11.9 months age group, 57.6% in participants 12-23.9 months of age and 48.2% in the oldest group). The prevalence of Se defciency is lower among children living in the western regions (38.3%) than among those from other areas of the country (60.4%). Conclusion: The high prevalence of Se defciency among Mongolian children shows that a wider survey that looks at the relationship between the blood Se and its concentrations in food and soil is needed.

Background:Selenium (Se) is a trace element important for health. Its defciency has adverse effects on reproduction, immunocompetence and cardiovascular status. There is growing evidence that higher Se intakes are associated with reduced cancer risk. To date, there have been no studies conducted on the Se status of Mongolian children. Materials and Methods Non-fasting morning blood samples were collected from 240 children (122 male and 118 female) 6-36 months of age from the capital city of Mongolia and four provinces located in the south, north, east and west of the country. Inclusion criteria were apparently healthy children with no evidence of infection within the previous 7 days. The serum concentrations of Se were determined using graphite furnace atomic absorption spectrometry.Results:The mean serum Se concentration was 0.79 µmol/L. The indicator was higher for children in the rural provinces compared to those who lived in the capital city (0.81 µmol/L vs. 0.76 µmol/L, p=0.029). There was no statistically signifcant difference in the levels of Se detected between boys and girls (0.79 µmol/Lvs. 0.78 µmol/L, p=0.551). The serum concentration of Se increased with age (0.73µmol/L in the 6-11.9 months age group, 0.79 µmol/L in children aged 12-23.9 months and 0.82 µmol/L in 24-36-month-old participants). The prevalence of low serum Se in the surveyed population (<0.82 μmol/L) was 55.8%. The Se defciency tends to decrease with age (63.8% in the 6-11.9 months age group, 57.6% in participants 12-23.9 months of age and 48.2% in the oldest group). The prevalence of Se defciency is lower among children living in the western regions (38.3%) than among those from other areas of the country (60.4%).Conclusion:The high prevalence of Se defciency among Mongolian children shows that a wider survey that looks at the relationship between the blood Se and its concentrations in food and soil is needed.

Introduction. The high rate of malnutrition in young Mongolian children is a serious issue. Anemia, stunting and rickets have all been identified as significant problems. Low levels of serum folate have been reported among some young children in two previous surveys. Zinc is a growth-limiting micronutrient that may contribute to the persistent stunting in young Mongolian children. The traditional rice and wheat-based complementary foods used for young child feeding are likely to be inadequate in zinc. Certainly, the overall prevalence of stunting in Mongolia (i.e., 20%) is suggestive of substantial risk of zinc deficiency. It is possible that co-existing low selenium status may exacerbate zinc deficiency, because selenium compounds regulate the delivery of zinc from metallothioneine to zinc enzymes. To date, however, there have been no studies on the selenium and zinc status of the Mongolian population. Study objective. The objective of this study was to assess the biochemical indicators of micronutrient deficiency among 6-36 months old children. Subjects and methods. This cross-sectional study was conducted in four districts of Ulaanbaatar city and in centers of Bulgan, Bayanhongor, Dornod and Khovd aimags and included 243 (122 male and 121 female) apparently healthy children aged 6 to 36 months. Hemoglobin analysis was performed using a hemoglobinometer Hemocue AB, serum ferritin was analyzed by enzyme immunoassay technology, serum retinol by high-pressure liquid chromatography, serum zinc and selenium were analyzed by atomic absorption spectrophotometry and serum 25(OH)D analysis was performed using radioimmuno assay procedure. Results. Mean hemoglobin, serum ferritin, folate, 25(OH)D, retinol, zinc and selenium concentrations in children from Ulaanbaatar city and aimag centers were determined. Age-group differences for the means were significant for hemoglobin, serum ferritin, serum folate (p=0.001)and serum zinc(p=0.01). The differences between Ulaanbaatar and the aimag centers were also significant for hemoglobin, serum ferritin, serum zinc (p=0.05) and serum folate (p=0.001). 24.3% of the children were anemic. The prevalence of anemia was greater among the children in the aimag centers than in Ulaanbaatar city and in younger children than in the oldest age group. The prevalence of iron deficiency anemia was 15.3% and was independent of setting but was lowest in the oldest children aged 24 to 36 months. Of all the surveyed children, only 3.7% had low level of serum folate. The overall prevalence of low serum retinol levels indicative of vitamin A deficiency was 33.7%, with no differences by setting or age group. 74.7% of the children had low serum zinc concentrations. There was no significant difference in the prevalence between children living in Ulaanbaatar city and the aimag centers, or among the three age groups of children in either setting. The overall prevalence of low serum selenium concentrations was 57.7%, with no differences in the prevalence by setting or age-group. The prevalence of low serum levels of 25(OH)D was 61% and was highest among the children aged 6 to 12 months of Ulaanbaatar city. Conclusion: 1. Zinc deficiency had the highest prevalence (74.7%) among the surveyed children, followed by low serum selenium levels (57.7%). 2. 36% of the children were at risk of two and 64% of more than two coexisting micronutrient deficiencies. 3. There is a need for multi-micronutrient programs that take into account the potential interactions of micronutrients instead of the present single micronutrient based interventions on-going in Mongolia.