Prevalence and risk factors of anemia in internationally adopted children: a cohort study

TL;DR

This study examines how common anemia is in internationally adopted children and identifies risk factors like skin color and origin region.

Contribution

The study provides new insights into anemia risk factors in internationally adopted children using a large cohort and multivariable analysis.

Findings

Children from Asia and India had lower weight and height compared to those from Africa and Latin America.

Anemia was more prevalent in children with black skin color and those from Africa and India.

Hemoglobin levels were not associated with BMI, creatinine, or liver enzymes.

Abstract

Adoptive children, who have often experienced inadequate healthcare, malnutrition, and exposure to infectious diseases in their countries of origin, are vulnerable to a range of health problems among which anemia is a major one, potentially leading to long term sequelae. We aimed to investigate the prevalence and risk factors associated with anemia in a cohort of internationally adopted children evaluated at the Pediatric Clinic of the Policlinico Universitario “A. Gemelli” in Rome. between 2007 and 2023.

Retrospective cohort analysis. Demographic and hematological data were collected for each child. Associations between categorical variables was studied with Pearson’s or Fisher’s test and between quantitative and qualitative variables with Analysis of Variance (ANOVA) with Bonferroni correction. The occurrence of a Hb level inferior to -2SD and that of presenting together Hb Z score < -2SD for and low ferritin have been considered as a binary outcome and studied with multivariable logistic regression models.

Nine hundred and sixty-nine children have been enrolled. Weight and height were significantly lower in children from Asia and India compared to Africa and Latin America. Hb z-scores were significantly lower in the 11–18 age group compared to all other age groups. In univariate analysis, Hb z-scores were associated with black skin color and the presence of parasites in stool. Hemoglobin levels were not associated with patient BMI, creatinine levels, bilirubin, TSH, FT3, FT4, AST, or ALT. The mean corpuscular volume (MCV) was associated in univariate analysis with age at arrival, skin color, Macro-area of origin, duration of institutional stay, iron levels. At same MCV, Hb was higher in Asia compared to Africa (p < 0.001). 55 patients had both Hb and MCV values below two SD. These patients are predominantly characterized by black skin color and originating from Africa and India.

There is possibly a complex interplay between environmental exposures and genetic predispositions in shaping the health outcomes of adopted children. Healthcare providers who care for internationally adopted children should prioritize comprehensive health assessments that include screening for anemia, nutritional deficiencies, and parasitic infections.

The online version contains supplementary material available at 10.1186/s13052-025-01944-6.

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