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Impact of inflammation on the biomarkers of iron status in a cross-sectional survey of Lao women and children

  • Jacqueline Knowles (a1), David I. Thurnham (a2), Bounthom Phengdy (a3), Keonakhone Houamboun (a4), Khamseng Philavong (a5), Intong Keomoungkhone (a6) and Khamhoung Keovilay (a6)...

Abstract

Anaemia is prevalent in South East Asia and Fe deficiency (ID) is considered to be the main cause, but the role of subclinical inflammation in the aetiology is uncertain. In the present study, we determined the influence of inflammation on the biomarkers of Fe status in women and children, and herein, we discuss the proportion of anaemia associated with ID. As part of the 2006 Lao People's Democratic Republic (The Lao PDR) National Nutrition Survey, blood collected from 482 young children and 816 non-pregnant women was analysed. Plasma ferritin, transferrin receptor (sTfR), Hb, C-reactive protein (CRP) and α-1-acid glycoprotein (AGP) concentrations were measured. ID was assessed using ferritin concentrations ( < 12 (children) or < 15 (adults) μg/l), sTfR concentrations (>8·3 mg/l) and body Fe stores (BIS < 0). Elevated CRP (>5 mg/l) and/or AGP (>1 g/l) concentrations were used to categorise inflammation status in order to correct the Fe biomarkers for inflammation. Inflammation was present in 14 % of adults and 43 % of children. Anaemia was present in 37·6 % of both women (Hb concentrations < 120 g/l) and children (Hb concentrations < 110 g/l). Correcting ferritin concentrations for inflammation increased the prevalence of ID from 24·3 to 26 % for women and from 18 to 21 % for children (P< 0·001 for both). Ferritin concentrations were more helpful in detecting ID than sTfR concentrations or BIS, but regression analysis found that sTfr concentrations explained more of the variance in Hb concentrations in both women (20 %) and children (17 %) than ferritin concentrations (5 and 1·4 %, respectively). Nevertheless, the total variance in Hb concentrations explained was only 26 and 18 % in women and children, respectively, and other factors may be more important than ID in contributing to anaemia in The Lao PDR.

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Corresponding author

*Corresponding author: J. Knowles, email jacky@publicnutritionsolutions.com

References

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1Gibson, RS, Abebe, Y, Stabler, S, et al. (2008) Zinc, gravida, infection, and iron, but not vitamin B-12 or folate status, predict hemoglobin during pregnancy in Southern Ethiopia. J Nutr 138, 581586.
2UNICEF, UNU & WHO (2001) Iron Deficiency Anaemia. Assessment, Prevention and Control. A Guide for Programme Managers no. WHO/NHD/01.3. Geneva: World Health Organization.
3Thurnham, DI, Mburu, ASW, Mwaniki, DL, et al. (2008) Using plasma acute-phase protein concentrations to interpret nutritional biomarkers in apparently healthy HIV-1-seropositive Kenyan adults. Br J Nutr 100, 174182.
4Darboe, MK, Thurnham, DI, Morgan, G, et al. (2007) Effectiveness of the new IVACG early high-dose vitamin A supplementation scheme compared to the standard WHO protocol: a randomised controlled trial in Gambian mothers and infants. Lancet 369, 20882096.
5Mburu, ASW, Thurnham, DI, Mwaniki, DL, et al. (2008) The influence and benefits of controlling for inflammation on plasma ferritin and hemoglobin responses following a multi-micronutrient supplement in apparently-healthy, HIV+Kenyan adults. J Nutr 138, 613619.
6Cook, JD, Skikne, BS & Baynes, RD (1993) Serum transferrin receptor. Ann Rev Med 44, 6374.
7Beesley, R, Filteau, SM, Tomkins, A, et al. (2000) Impact of acute malaria on plasma concentrations of transferrin receptors. Trans R Soc Trop Med Hyg 94, 295298.
8Cook, JD, Flowers, CH & Skikne, D (2003) The quantitative assessment of body iron. Blood 101, 33593363.
9Ganz, T (2007) Molecular control of iron transport. J Am Soc Nephrol 18, 394400.
10Thurnham, DI, McCabe, GP, Northrop-Clewes, CA, et al. (2003) Effect of subclinical infection on plasma retinol concentrations and assessment of prevalence of vitamin A deficiency: meta-analysis. Lancet 362, 20522058.
11Beard, JL, Murray-Kolb, LE, Rosales, FJ, et al. (2006) Interpretation of serum ferritin concentrations as indicators of total-body iron stores in survey populations: the role of biomarkers for the acute phase response. Am J Clin Nutr 84, 14981505.
12Lao PDR (2006) Monitoring the situation of children and women. Multiple Indicator Cluster Survey. http://www.childinfo.org/files/MICS3_Lao_FinalReport_2006_Eng.pdf.
13Erhardt, JG, Estes, JE, Pfeiffer, CM, et al. (2004) Combined measurement of ferritin, soluble transferrin receptor, retinol binding protein, and C-reactive protein by an inexpensive, sensitive, and simple sandwich enzyme-linked immunosorbent assay technique. J Nutr 134, 31273132.
14Thurnham, DI, McCabe, LD, Haldar, S, et al. (2010) Adjusting plasma ferritin concentrations to remove the effects of subclinical inflammation in the assessment of iron deficiency: a meta-analysis. Am J Clin Nutr 92, 546555.
15World Health Organization & CDC (2004) Assessing the Iron Status of Populations. Geneva: WHO Press.
16Centres for Disease Control and Prevention (1998) Recommendations to prevent and control iron deficiency in the United States. Morb Mortal Wkly Rep 47, 129.
17Pritchett, L & Filmer, D (2001) Estimating wealth effects without expenditure data – or tears: an application to educational enrolments in states of India. Demography 38, 115132.
18Rutstein, SO & Johnson, K (2004) The DHS wealth index. In Demographic and Health Survey Comparative Reports, Volume 6. Calverton, MD: ORC Macro.
19Punnonen, K, Irjala, K & Rajamaki, A (1997) Serum transferrin receptor and its ratio to serum ferritin in the diagnosis of iron deficiency. Blood 89, 10521057.
20Olivares, M, Tomás, W, Cook, JD, et al. (2000) Usefulness of serum transferrin receptor and serum ferritin in diagnosis of iron deficiency in infancy. Am J Clin Nutr 72, 11911195.
21George, J, Yiannakis, M, Main, B, et al. (2012) Genetic hemoglobin disorders, infection, and deficiencies of iron and vitamin A determine anemia in young Cambodian children. J Nutr 142, 781787.
22Collins, JF, Wessling-Resnick, M & Knutson, MD (2008) Hepcidin regulation of iron transport. J Nutr 138, 22842288.
23Grant, FK, Suchdev, PS, Flores-Ayala, R, et al. (2012) Correcting for inflammation changes estimates of iron deficiency among rural Kenyan preschool children. J Nutr 142, 105111.
24Zimmermann, MB, Fucharoen, S, Winichagoon, P, et al. (2008) Iron metabolism in heterozygotes for hemoglobin E (HbE), alpha-thalassemia 1, or beta-thalassemia and in compound heterozygotes for HbE/beta-thalassemia. Am J Clin Nutr 88, 10261031.
25Thurlow, RA, Winichagoon, P, Green, T, et al. (2005) Only a small proportion of anemia in northeast Thai schoolchildren is associated with iron deficiency. Am J Clin Nutr 82, 380387.
26Anderson, VP, Jack, S, Monchy, D, et al. (2008) Co-existing micronutrient deficiencies among stunted Cambodian infants and toddlers. Asia Pac J Clin Nutr 17, 7279.
27Sanchaisuriya, K, Fucharoen, S, Ratanasiri, T, et al. (2006) Thalassemia and hemoglobinopathies rather than iron deficiency are major causes of pregnancy-related anemia in northeast Thailand. Blood Cells Mol Dis 37, 811.
28Savongsy, O, Fucharoen, S, Fucharoen, G, et al. (2008) Thalassemia and hemoglobinopathies in pregnant Lao women: carrier screening, prevalence and molecular basis. Ann Hematol 87, 647654.
29Fucharoen, G, Sanchaisuriya, K, Sae-Ung, N, et al. (2004) A simplified screening strategy for thalassaemia and haemoglobin E in rural communities in south-east Asia. Bull WHO 82, 364372.
30Fishman, SM, Christian, P & West, KP Jr (2000) Role of vitamins in the prevention and control of anaemia. Public Health Nutr 3, 125150.

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