Public Health Nutrition

HOT TOPIC – Nutrition in low and middle income countries

High blood manganese in iron-deficient children in Karachi

Mohammad Ataur Rahmana1, Bushra Rahmana1 and Nessar Ahmeda2 c1

a1 Karachi Institute of Biotechnology and Genetic Engineering, University of Karachi, Karachi, Pakistan

a2 School of Healthcare Science, Manchester Metropolitan University, Manchester M1 5GD, UK


Objective Dietary Fe deficiency has a high incidence in Pakistani children and may be associated with increased gastrointestinal absorption of trace metals such as Mn. Therefore, children residing in heavily polluted cities like Karachi may be prone to Mn toxicity. The present study investigated blood Mn concentrations in Karachi children of different Fe statuses.

Design A prospective observational study was conducted where children were classified into different categories of Fe status – normal Fe, borderline Fe deficiency, Fe deficiency and Fe-deficiency anaemia – using WHO criteria supported by measurements of soluble transferrin receptors. Blood Mn was determined for children in each category using graphite atomic absorption spectroscopy.

Setting Three hospital outpatient departments in Karachi, Pakistan.

Subjects A total of 269 children (156 males, 113 females) aged 6–60 months from low-income families of Karachi.

Results Blood Mn concentrations were significantly higher in children with Fe-deficiency anaemia and Fe deficiency compared with those of normal Fe status (both P < 0·01). Blood concentrations of soluble transferrin receptors were higher in children with Fe-deficiency anaemia compared with those of borderline or normal Fe status (both P < 0·05).

Conclusions These findings report for the first time high blood Mn concentrations in Fe-deficient children of this age group. There is therefore an urgent need to identify and remove environmental exposure to Mn in combination with health strategies aimed at eradicating childhood Fe deficiency.

(Received July 19 2012)

(Revised February 07 2013)

(Accepted February 20 2013)

(Online publication March 27 2013)


  • Manganese;
  • Iron-deficiency anaemia;
  • Manganism;
  • Soluble transferrin receptor;
  • Karachi


c1 Corresponding author: Email