Correcting for Inflammation Changes Estimates =of Iron Deficiency among Rural Kenyan Preschool Children3

Grant, Frederick; Suchdev, Parminder S.; Flores‐Ayala, Rafael; Cole, Conrad R.; Ramakrishnan, Usha; Ruth, Laird J.; Martorell, Reynaldo

doi:10.3945/jn.111.146316

Cited by 62 publications

(65 citation statements)

References 22 publications

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“…Further, as indicated by the high hepcidin values, anemia of chronic disease may have played a role in sequestering iron and thus decreasing CHr levels (41). We showed sTfR to be negatively correlated with inflammation as measured by AGP, which is contrary to prior literature that has shown a positive association between inflammation and AGP (42, 43). In populations with acute inflammation, sTfR has a positive relationship with AGP and hence adjusting it would decrease estimated iron deficiency prevalence.…”

Section: Discussioncontrasting

confidence: 99%

Use of Reticulocyte Hemoglobin Content in the Assessment of Iron Deficiency in Children With Inflammatory Bowel Disease

Syed

Kugathasan

Kumar

et al. 2017

J. pediatr. gastroenterol. nutr.

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BACKGROUND Iron deficiency and anemia affect up to 50–75% of inflammatory bowel disease (IBD) patients. Iron deficiency in IBD may be difficult to diagnose because of the effect of inflammation on iron status biomarkers. Thus, there is a need for better methods to accurately determine iron status in IBD. OBJECTIVE To investigate the association of inflammation with hemoglobin content of reticulocytes (CHr) and the utility of CHr in comparison to standard iron biomarkers. DESIGN/METHODS We conducted a cross-sectional study of children with IBD. Iron biomarkers [CHr, ferritin, soluble transferrin receptor (sTfR), hepcidin, hemoglobin] were measured along with systemic biomarkers of inflammation [C-reactive protein (CRP), α1-acid glycoprotein (AGP)]. Spearman correlations were used to evaluate the relationship of inflammation and iron biomarkers. The gold standard for iron deficiency was defined as inflammation-corrected ferritin < 15 μg/L or sTfR > 8.3mg/L. Receiver operating characteristic (ROC) curves were used to estimate the prognostic values of all iron biomarkers to identify patients with iron deficiency. RESULTS We analyzed data in 62 children aged 5 to < 19 years. Sixty-nine % of our subjects had Crohn’s disease and 31% had ulcerative colitis, of which 42% were females and 53% African American. The prevalence of anemia was 32%, of iron deficiency was 52% using ferritin < 15 μg/L or sTfR > 8.3mg/L, 39% using RDW>14.5%, 26% using BIS<0mg/kg body weight, 25% using CHr <28 pg and 11% using MCV <75fL/cell. After correcting ferritin and sTfR levels for inflammation, the prevalence of iron deficiency was 68%. CHr was correlated with CRP (rs −0.44, p < 0.001) and AGP (rs −0.37, p < 0.05). The optimal prognostic value for inflammation-adjusted CHr to predict iron deficiency was 34 pg (area under the ROC of 0.70), with 88% sensitivity and 30% specificity. CONCLUSIONS Iron deficiency and anemia are very common in this pediatric IBD cohort. All explored iron biomarkers, including CHr, were affected by inflammation and should be adjusted. A single iron biomarker is unlikely to best predict iron deficiency in pediatric IBD. Iron intervention studies are needed to examine the response of iron biomarkers to iron supplementation in the setting of inflammation.

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Section: Discussioncontrasting

confidence: 99%

Use of Reticulocyte Hemoglobin Content in the Assessment of Iron Deficiency in Children With Inflammatory Bowel Disease

Syed

Kugathasan

Kumar

et al. 2017

J. pediatr. gastroenterol. nutr.

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“…Details of the laboratory analyses have been described in detail elsewhere (15). In summary, capillary blood was obtained at baseline and at 12 mo of follow-up for determinations of hemoglobin, ferritin, C-reactive protein (CRP), α -1-acid glycoprotein (AGP), and retinol-binding protein (RBP).…”

Section: Methodsmentioning

confidence: 99%

“…The following thresholds were used to define abnormal values for these biochemical indicators: ferritin concentration <12 μ g/L, RBP concentration <0.7 μ mol/L, CRP concentration >5 mg/L, and AGP concentration >1 g/dL. Iron deficiency and vitamin A deficiency were adjusted for the effect of inflammation with the use of a correction-factor approach to adjust values of ferritin and RBP on the basis of the elevated acute-phase proteins CRP and AGP as described previously (15, 17). Correction factors for ferritin and RBP were as follows: 0.64 and 1.28, respectively, for early inflammation (elevated CRP and normal AGP), 0.31 and 1.38, respectively, for early convalescent inflammation (elevated CRP and AGP), and 0.64 and 1.09, respectively, for late convalescent inflammation (elevated AGP and normal CRP).…”

Section: Methodsmentioning

confidence: 99%

Effects of community-based sales of micronutrient powders on morbidity episodes in preschool children in Western Kenya

Suchdev

Addo

Martorell

et al. 2016

The American Journal of Clinical Nutrition

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Background Although the use of micronutrient powders (MNPs) is considered the preferred approach for childhood anemia control, concerns about iron-related morbidity from clinical trials have challenged programmatic scale-up. Objective We aimed to measure the effects of community-based sales of MNPs on diarrhea-, fever-, cough-, and malaria-morbidity episodes in children 6–35 mo of age. Design We conducted a cluster-randomized trial in rural Western Kenya where 60 villages were randomly assigned to either intervention or control groups. MNPs (containing iron, vitamin A, zinc, and 11 other micronutrients) and other health products (e.g., insecticide-treated bednets, soap, and water disinfectant) were marketed in 30 intervention villages from June 2007 to March 2008. Household visits every 2 wk were used to monitor self-reported MNP use and morbidity (illness episodes in the previous 24 h and hospitalizations in the previous 2 wk) in both groups. Iron, vitamin A, anemia, malaria, and anthropometric measures were assessed at baseline and at 12 mo of follow-up. Data were analyzed by intent-to-treat analyses. Results Of 1062 children enrolled in the study, 1038 children (97.7%) were followed (a total of 14,204 surveillance visits). Mean MNP intake in intervention villages was 0.9 sachets/wk. Children in intervention villages, compared with children in control villages, had ~60% fewer hospitalizations for diarrhea (0.9% compared with 2.4%, respectively; P = 0.03) and 70% fewer hospitalizations for fever (1.8% compared with 5.3%, respectively; P = 0.003) but no significant differences in hospitalizations for respiratory illness (1.1% compared with 2.2%, respectively; P = 0.11) or malaria (3.1% compared with 2.9%, respectively; P = 0.82). There were no differences between groups in the numbers of episodes of diarrhea, cough, or fever. Conclusions MNP use in Western Kenya through market-based community sales was not associated with increased infectious morbidity in young children and was associated with decreased hospitalizations for diarrhea and fever. An integrated distribution of MNPs with other health interventions should be explored further in settings with a high child malnutrition and infection burden. This trial was registered at clinicaltrials.gov as NCT01088958.

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“…Ferritin, C-reactive protein (CRP), transferrin receptor (TfR), α-1-acid glycoprotein (AGP), and retinol binding protein (RBP) were analyzed using a sandwich enzyme-linked immunosorbent assay (ELISA) technique (VitA-Iron Laboratory, Germany) 23. Low ferritin was defined as a plasma ferritin concentration < 12 μg/L,24,25 and iron deficiency was defined as low ferritin in the absence of inflammation (a CRP level ≤ 5 mg/L and an AGP level ≤ 1 g/L) 26. Although TfR data were collected, we did not include it in this analysis because of the potential effect of malaria, inflammation, and hemoglobinopathies on TfR levels 27.…”

Section: Methodsmentioning

confidence: 99%

Nutritional Status of Young Children with Inherited Blood Disorders in Western Kenya

Tsang¹,

Sullivan²,

Ruth³

et al. 2014

The American Society of Tropical Medicine and Hygiene

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To determine the association between a range of inherited blood disorders and indicators of poor nutrition, we analyzed data from a population-based, cross-sectional survey of 882 children 6–35 months of age in western Kenya. Of children with valid measurements, 71.7% were anemic (hemoglobin < 11 g/dL), 19.1% had ferritin levels < 12 μg/L, and 30.9% had retinol binding protein (RBP) levels < 0.7 μmol/L. Unadjusted analyses showed that compared with normal children, homozygous α+-thalassemia individuals had a higher prevalence of anemia (82.3% versus 66.8%, P = 0.001), but a lower prevalence of low RBP (20.5% versus 31.4%, P = 0.024). In multivariable analysis, homozygous α+-thalassemia remained associated with anemia (adjusted odds ratio [aOR] = 1.8, P = 0.004) but not with low RBP (aOR = 0.6, P = 0.065). Among young Kenyan children, α+-thalassemia is associated with anemia, whereas G6PD deficiency, haptoglobin 2-2, and HbS are not; none of these blood disorders are associated with iron deficiency, vitamin A deficiency, or poor growth.

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Correcting for Inflammation Changes Estimates =of Iron Deficiency among Rural Kenyan Preschool Children3

Cited by 62 publications

References 22 publications

Use of Reticulocyte Hemoglobin Content in the Assessment of Iron Deficiency in Children With Inflammatory Bowel Disease

Use of Reticulocyte Hemoglobin Content in the Assessment of Iron Deficiency in Children With Inflammatory Bowel Disease

Effects of community-based sales of micronutrient powders on morbidity episodes in preschool children in Western Kenya

Nutritional Status of Young Children with Inherited Blood Disorders in Western Kenya

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