Skip to main content Accessibility help
×
Home

Using plasma acute-phase protein concentrations to interpret nutritional biomarkers in apparently healthy HIV-1-seropositive Kenyan adults

  • David I. Thurnham (a1), Anne S. W. Mburu (a2), David L. Mwaniki (a2), Erastus M. Muniu (a2), Fred Alumasa (a2) and Arjan de Wagt (a3)...

Abstract

Inflammation influences the assessment of nutritional status. For example, inflammation reduces plasma retinol concentrations and vitamin A deficiency is overestimated. Conversely inflammation increases plasma ferritin concentrations and Fe deficiency is underestimated. Blood samples were obtained from 163 free-living HIV-1-infected adults, not on continuous medication, anti-retroviral drugs or micronutrients, not unwell and who had not reached WHO stage IV of HIV/AIDS. We used four markers of inflammation, C-reactive protein (CRP), α1-acid glycoprotein (AGP), α1-antichymotrypsin and erythrocyte sedimentation rate but mainly CRP and AGP were used to separate the subjects into four groups: ‘healthy’ where both CRP and AGP were normal; ‘incubation phase’ where CRP was elevated; ‘early convalescence’ where AGP and CRP were elevated and ‘late convalescence’ where only AGP was elevated. Correction factors were calculated to remove the influence of inflammation from each biomarker and group where inflammation was present and the data are shown before and after recalculation. The correction increased median plasma retinol concentrations of the whole group from 1·16 to 1·33 μmol/l, comparable with values (mean 1·29 μmol/l) in HIV-negative Kenyan women. Median ferritin concentrations fell by about 50 % in both sexes and the number of women with plasma ferritin concentrations ≤ 12 μg/l increased from eleven to twenty. The correction also increased plasma carotenoids and Hb but not α-tocopherol concentrations. We suggest that the method described to remove the influence of inflammation from nutritional biomarkers should be generally applicable in apparently healthy people and prevents discarding valuable data because of mild inflammation. The method does now need to be tested in other populations.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Using plasma acute-phase protein concentrations to interpret nutritional biomarkers in apparently healthy HIV-1-seropositive Kenyan adults
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Using plasma acute-phase protein concentrations to interpret nutritional biomarkers in apparently healthy HIV-1-seropositive Kenyan adults
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Using plasma acute-phase protein concentrations to interpret nutritional biomarkers in apparently healthy HIV-1-seropositive Kenyan adults
      Available formats
      ×

Copyright

Corresponding author

*Corresponding author: Professor David I. Thurnham. Current address MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge CBI 9NL, UK, fax +44 2870 324965, email di.thurnham@ulster.ac.uk

References

Hide All
1Thurnham, DI (1997) Impact of disease on markers of micronutrient status. Proc Nutr Soc 56, 421431.
2Louw, JA, Werbeck, A, Louw, MEJ, Kotze, TJvW, Cooper, R & Labadarios, D (1992) Blood vitamin concentrations during the acute-phase response. Critical Care Med 20, 934941.
3Thurnham, DI & Singkamani, R (1991) The acute phase response and vitamin A status in malaria. Trans R Soc Trop Med Hyg 85, 194199.
4Beisel, WR (1976) Trace elements in infectious processes. Med Clin North Am 60, 831849.
5Feelders, RA, Vreugdenhil, G, Eggermont, AMM, Kuiper-Kramer, PA, van Eijk, HG & Swaak, AJG (1998) Regulation of iron metabolism in the acute-phase response: interferon-γ and tumor necrosis factor-α induce hypoferraemia, ferritin production and a decrease in circulating transferrin receptors in cancer patients. Eur J Clin Invest 28, 520527.
6Kritchevsky, SB, Bush, AJ, Pahor, M & Gross, MD (2000) Serum carotenoids and markers of inflammation in non-smokers. Am J Epidemiol 152, 10651071.
7Erlinger, TP, Guallar, E, Miller, ER, Stolzenberg-Solomon, R & Appel, LJ (2001) Relationship between systemic markers of inflammation and serum β-carotene levels. Arch Intern Med 161, 19031908.
8Galloway, P, McMillan, DC & Sattar, N (2000) Effect of the inflammatory response on trace element and vitamin status. Ann Clin Biochem 37, 289297.
9Bates, CJ, Pentieva, KD, Prentice, A, Mansoor, MA & Finch, S (1999) Plasma pyridoxal phosphate and pyridoxic acid and their relationship to plasma homocysteine in a representative sample of British men and women aged 65 years and over. Br J Nutr 81, 191201.
10Fleck, A & Myers, MA (1985) Diagnostic and prognostic significance of acute phase proteins. In The Acute Phase Response to Injury and Infection, pp. 249271 [Gordonand, AH and Koj, A, editors]. Amsterdam: Elsevier Scientific Publishers.
11Calvin, J, Neale, G, Fotherby, KJ & Price, CP (1988) The relative merits of acute phase proteins in the recognition of inflammatory conditions. Ann Clin Biochem 25, 6066.
12Thompson, D, Milford-Ward, A & Whicher, JT (1992) The value of acute phase protein measurements in clinical practice. Ann Clin Biochem 29, 123131.
13Stuart, J & Whicher, JT (1988) Tests for detecting and monitoring the acute phase response. Arch Dis Child 63, 115117.
14Thurnham, DI, McCabe, GP, Northrop-Clewes, CA & Nestel, P (2003) Effect of subclinical infection on plasma retinol concentrations and assessment of prevalence of vitamin A deficiency: meta-analysis. Lancet 362, 20522058.
15Baeten, JM, McClelland, RS, Richardson, BA, et al. (2002) Vitamin A deficiency and the acute phase response among HIV-1-infected and -uninfected women in Kenya. J Acquir Immune Defic Syndr 31, 243249.
16Mburu, ASW, Mwaniki, DL, Thurnham, DI, Selenje, L, de Wagt, A, Muniu, EM, Friis, H & Krarup, HB (2004) Effects of multi-micronutrient supplements and food aid rations on the nutritional status and health of HIV+ adults (MINIFAR) (Report to UNICEF July 2004), pp. 1209. Nairobi, Kenya: CPHR-KEMRI.
17Thurnham, DI, Mburu, ASW, Mwaniki, DL & de Wagt, A (2005) Micronutrients in childhood and the influence of subclinical inflammation. Proc Nutr Soc 64, 502509.
18Krarup, HB, Drewes, AM & Madsen, PH (1998) A quantitative HCV-PCR test for routine diagnositics. Scand J Clin Lab Invest 58, 415422.
19Thurnham, DI, Smith, E & Flora, PS (1988) Concurrent liquid-chromatographic assay of retinol, α-tocopherol, β-carotene, α-carotene, lycopene and β-cryptoxanthin in plasma with tocopherol acetate as internal standard. Clin Chem 34, 377381.
20Thurnham, DI, Northrop-Clewes, CA, Paracha, PI & McLoone, UJ (1997) The possible significance of parallel changes in plasma lutein and retinol in Pakistani infants during the summer season. Br J Nutr 78, 775784.
21Sommer, A & Davidson, FR (2002) Assessment of control and vitamin A deficiency: the Annecy accords. J Nutr 132, 2845S2851S.
22UNICEF, , UNU, & WHO, (2001) Iron Deficiency Anaemia. Assessment, Prevention and Control. A Guide for Programme Managers, pp. 1–114. WHO/NHD/01.3. Geneva, Switzerland: World Health Organization.
23Worwood, M (1982) Ferritin in human tissues and serum. Clin Haematol 11, 275307.
24Thurnham, DI, Davies, JA, Crump, BJ, Situnayake, RD & Davis, M (1986) The use of different lipids to express serum tocopherol:lipid ratios for the measurement of vitamin E status. Ann Clin Biochem 23, 514520.
25Mwaniki, DL, Omwega, AM, Minui, EM, Mutunga, JN, Akelola, R, Shako, BR, Gotink, MH & Pertet, AM (2001) Anaemia and status of iron, vitamin A and zinc in Kenya. The 1999 National Survey Report. pp. 1221. Nairobi, Ministry of Health.
26Baeten, JM, Wener, MH, Bankson, DD, Lavreys, L, Richardson, BA, Mandaliya, K, Bwayo, JJ & McClelland, RS (2006) HIV-1 infection alters the retinol-binding protein:transthyretin ratio even in the absence of the acute phase response. J Nutr 136, 16241629.
27Gieng, SH & Rosales, FJ (2006) Plasma alpha1-acid glycoprotein can be used to adjust inflammation-induced hyporetinolemia in vitamin A-sufficient, but not vitamin A-deficient or -supplemented rats. J Nutr 136, 19041909.
28Beard, JL, Murray-Kolb, LE, Rosales, FJ, Solomons, NW & Angelilli, ML (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.
29Mitra, AK, Alvarez, JO, Wahed, MA, Fuchs, GJ & Stephensen, CB (1998) Predictors of serum retinol in children with shigellosis. Am J Clin Nutr 68, 10881094.
30Reddy, V, Bhaskaram, P, Raghuramulu, N, Milton, RC, Rao, V, Madhusudan, J & Radha Krishna, KV (1986) Relationship between measles, malnutrition, and blindness: a prospective study in Indian children. Am J Clin Nutr 44, 924930.
31Irlam, JH, Visser, ME, Rollins, N & Siegfried, N (2005) Micronutrient supplementation in children and adults with HIV infection. Cochrane Database Syst Rev 4 CD 003650.
32Rosales, FJ, Ritter, SJ, Zolfaghari, R, Smith, JE & Ross, AC (1996) Effects of acute inflammation on plasma retinol, retinol-binding protein, and its messenger RNA in the liver and kidneys of vitamin A sufficient rats. J Lipid Res 37, 962971.
33Tabone, MD, Muanza, K, Lyagoubi, M, Jardel, C, Pied, S & Amedee-Manesme, O (1992) The role of interleukin-6 in vitamin A deficiency during Plasmodium falciparum malaria and possible consequences for vitamin A supplementation. Immunol 75, 553554.
34Sommerburg, O, Langhans, C-D, Arnhold, J, Leichsenring, M, Salerno, C, Crifo, C, Hoffman, GF, Debatin, K-M & Siems, WG (2003) β-Carotene cleavage products after oxidation mediated by hypochlorous acid – A model for neutrophil-derived degradation. Free Rad Biol Med 35, 14801490.
35Chaudiere, J & Ferrari-Iliou, R (1999) Intracellular antioxidants from chemical to biochemical mechanisms. Food Chem Toxicol 37, 949962.
36Traber, MG, Ramakrishanan, R & Kayden, HJ (1994) Human plasma vitamin E kinetics demonstrate rapid recycling of plasma RRR-alpha-tocopherol. Proc Natl Acad Sci U S A 91, 1000510008.
37Wieringa, FT, Dijkhuizen, MA, West, CE, Northrop-Clewes, CA & Muhilal, (2002) Estimation of the effect of the acute phase response on indicators of micronutrient status in Indonesian infants. J Nutr 132, 30613066.
38Friis, H, Gomo, E, Koestel, P, Ndhlovu, P, Nyazema, N, Krarup, H & Michaelsen, KF (2001) HIV and other predictors of serum folate, serum ferritin, and hemoglobin in pregnancy: a cross-sectional study in Zimbabwe. Am J Clin Nutr 73, 10661073.
39Mehendale, SM, Shepherd, ME, Brookmeyer, RS, et al. (2001) Low carotenoid concentrations and the risk of HIV seroconversion in Pune, India. J Acquir Immune Defic Syndr 26, 352359.
40Dacie, JV & Lewis, SM (1995) Practical Haematology. London: Churchill Livingston.

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed