Cross-sectional Study to Identify the Range of Hemoglobin Levels in Normal Infants, Children, and Adolescents in India

In this population-based study, the authors constructed age-specific and sex-specific hemoglobin percentiles from values reported for a defined healthy population in the Comprehensive National Nutrition Survey (CNNS). Age-specific and sex-specific 5th percentiles of hemoglobin derived for this healthy population was used as the study cut-off to define anemia. These were compared with the existing WHO cut-offs to assess significant differences between them at each year of age and sex for quantifying the prevalence of anemia in the entire CNNS sample. From the CNNS survey 41210 participants had a hemoglobin value, 8087 of whom were included in this study and comprised the primary analytical sample. Compared with existing WHO cut-offs, the study cut-offs for hemoglobin were lower at all ages, usually by 1–2 g/dL, but more so in children of both sexes aged 1–2 years and in girls aged 10 years or older. Anemia prevalence with the study cut-offs was 19·2 percentage points lower than with WHO cut-offs in the entire CNNS sample with valid hemoglobin values across all ages and sexes (10·8% with study cut-offs vs 30·0% with WHO cut-offs). The authors concluded that these findings support the re-examination of WHO hemoglobin cut-offs to define anemia.