Assessment of Regression Models for Adjustment of Iron Status Biomarkers for Inflammation in Children with Moderate Acute Malnutrition in Burkina Faso

Cichon, Bernardette; Ritz, Christian; Fabiansen, Christian; Christensen, Vibeke Brix; Filteau, Suzanne; Friis, Henrik; Kæstel, Pernille

doi:10.3945/jn.116.240028

Cited by 19 publications

(19 citation statements)

References 37 publications

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“…Physical examinations found 72 % had clinical symptoms (fever, malaria, upper and lower respiratory tract infections and diarrhoea) and more than 24 % had a CRP concentration >10 mg/l and 66 % an AGP concentration >1 g/l. In spite of the high proportion with clinical symptoms, internally calculated CF for ferritin did not significantly differ from those calculated for all children in our meta-analysis (8) . However, the authors concluded that 'regression analysis is preferable to the CF approach when adjusting serum ferritin for inflammation as it accounts for severity of inflammation and morbidity, however, in clinical settings the use of the meta-analysis CF may be appropriate'.…”

contrasting

confidence: 81%

“…The meta-analysis studies were originally designed to be done on apparently healthy subjects with mild inflammation and correlations between the biomarkers and the APP would therefore be poor. The observations of Diana et al (1) and Cichon et al (8) suggest that some subjects with more severe inflammation can be included without seriously altering the CF obtained by meta-analysis. In the studies of Diana, Cichon and the BRINDA reports regression analysis produced greater corrections than the CF for all biomarkers studied.…”

mentioning

confidence: 99%

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Correcting nutritional biomarkers for the influence of inflammation

Thurnham

2017

Br J Nutr

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confidence: 81%

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confidence: 99%

Correcting nutritional biomarkers for the influence of inflammation

Thurnham

2017

Br J Nutr

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“…These findings were strengthened by the large sample size of the data set compared with in previous studies with similar findings (9–11). sTfR has been considered by many researchers as a potentially useful biomarker in settings where there is a high prevalence of inflammation because (unlike ferritin) it is not an APP and, therefore, is thought to not (28) or inconsistently (29) be influenced by inflammation. Notwithstanding, we showed that sTfR has a weak but consistent relation with AGP concentrations, which is associated with a lower prevalence of iron deficiency on the basis of measurements of sTfR, thereby indicating the need to apply adjustments for inflammation.…”

Section: Discussionmentioning

confidence: 99%

Adjusting soluble transferrin receptor concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project

Rohner¹,

Namasté

Larson

et al. 2017

The American Journal of Clinical Nutrition

103

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Background: Iron deficiency is thought to be one of the most prevalent micronutrient deficiencies globally, but an accurate assessment in populations who are frequently exposed to infections is impeded by the inflammatory response, which causes iron-biomarker alterations. Objectives: We assessed the relation between soluble transferrin receptor (sTfR) concentrations and inflammation and malaria in preschool children (PSC) (age range: 6–59 mo) and women of reproductive age (WRA) (age range: 15–49 y) and investigated adjustment algorithms to account for these effects. Design: Cross-sectional data from the Biomarkers Reflecting the Inflammation and Nutritional Determinants of Anemia (BRINDA) project from 11,913 PSC in 11 surveys and from 11,173 WRA in 7 surveys were analyzed individually and combined with the use of a meta-analysis. The following 3 adjustment approaches were compared with estimated iron-deficient erythropoiesis (sTfR concentration >8.3 mg/L): 1 ) the exclusion of individuals with C-reactive protein (CRP) concentrations >5 mg/L or α-1-acid glycoprotein (AGP) concentrations >1 g/L, 2 ) the application of arithmetic correction factors, and 3 ) the use of regression approaches. Results: The prevalence of elevated sTfR concentrations incrementally decreased as CRP and AGP deciles decreased for PSC and WRA, but the effect was more pronounced for AGP than for CRP. Depending on the approach used to adjust for inflammation, the estimated prevalence of iron-deficient erythropoiesis decreased by 4.4–14.6 and 0.3–9.5 percentage points in PSC and WRA, respectively, compared with unadjusted values. The correction-factor approach yielded a more modest reduction in the estimated prevalence of iron-deficient erythropoiesis than did the regression approach. Mostly, adjustment for malaria in addition to AGP did not significantly change the estimated prevalence of iron-deficient erythropoiesis. Conclusions: sTfR may be useful to assess iron-deficient erythropoiesis, but inflammation influences its interpretation, and adjustment of sTfR for inflammation and malaria should be considered. More research is warranted to evaluate the proposed approaches in different settings, but this study contributes to the evidence on how and when to adjust sTfR for inflammation and malaria.

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“…Samples were frozen and thawed only once before analysis. As previously described, SF data were corrected for inflammation using a linear model with CRP, AGP, and morbidity (malaria, lower respiratory tract infections, and history of fever; Cichon et al, ). Malaria ( Plasmodium falciparum ) was diagnosed from venous blood using a rapid diagnostic test (SD Bioline Malaria Ag Pf).…”

Section: Methodsmentioning

confidence: 99%

Early development in children with moderate acute malnutrition: A cross‐sectional study in Burkina Faso

Olsen

Iuel‐Brockdorff

Yaméogo

et al. 2019

Maternal & Child Nutrition

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Malnutrition impairs cognitive, communication, and motor development, but it is not known how nutrition and health are associated with development in children with moderate acute malnutrition (MAM). We aimed to describe motor and language development of children with MAM and explore its nutrition and health‐related correlates. This cross‐sectional study used baseline data from a nutritional trial in children with MAM aged 6–23 months in Burkina Faso. Motor and language skills were assessed using the Malawi Development Assessment Tool (MDAT). Linear mixed models were used to explore potential correlates of MDAT including socio‐economic status, anthropometry, body composition, whole‐blood polyunsaturated fatty acids (PUFA), haemoglobin (Hb), iron status, and morbidity. We also assessed child and caregiver participation during MDAT procedures and their associations with correlates and development. MDAT data were available for 1.608 children. Mean (95% CI) MDAT z‐scores were −0.39 (−0.45, −0.34) for gross motor, 0.54 (0.48, 0.59) for fine motor, and −0.91 (−0.96, −0.86) for language skills. Children with higher mid‐upper arm circumference, weight‐for‐height, height‐for‐age, fat‐free mass, n‐3 PUFAs, Hb, and iron status had better MDAT z‐scores, whereas children with more fat mass index, anaemia, illness, and inflammation had poorer z‐scores. In addition, children living in larger households or with an unmarried mother had poorer MDAT z‐scores. Associations between morbidity and z‐scores were largely explained by children's poorer participation during MDAT assessment. The identified factors associated with child development may inform interventions needed to stimulate development during or after management of MAM.

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Assessment of Regression Models for Adjustment of Iron Status Biomarkers for Inflammation in Children with Moderate Acute Malnutrition in Burkina Faso

Abstract: Cichon, B.; Ritz, C.; Fabiansen, C.; Christensen, V.B.; Filteau, S.; Friis, H.; Kstel, P. (2016)

Cited by 19 publications

References 37 publications

Correcting nutritional biomarkers for the influence of inflammation

Correcting nutritional biomarkers for the influence of inflammation

Adjusting soluble transferrin receptor concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project

Early development in children with moderate acute malnutrition: A cross‐sectional study in Burkina Faso

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