Effects of inflammation and Plasmodium falciparum infection on soluble transferrin receptor and plasma ferritin concentration in different age groups: a prospective longitudinal study in Côte d’Ivoire

Righetti, Aurélie A.; Wegmüller, Rita; Glinz, Dominik; Ouattara, Mamadou; Adiossan, Lukas G.; N’Goran, Eliézer K.; Utzinger, Jürg; Hurrell, Richard F.

doi:10.3945/ajcn.112.050302

Cited by 42 publications

(56 citation statements)

References 44 publications

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“…Successful treatment of anemia in this setting should rely on strategies based on this and other evidence of infectionrelated AI frequency. Our findings, combined with those of other recent studies, 6,25,28,29 suggest that both chronic infection and iron deficiency need to be addressed as part of integrated management of childhood anemia.…”

Section: Discussionsupporting

confidence: 53%

“…While it is unlikely that children in this age group were HIV positive, we did not determine HIV status for study participants, however there is always a chance that some of these children were HIV infected, which could have allowed additional undetected opportunistic infections that could have contributed to AI and so obscure the results of our parasite-focused analysis. This was a cross-sectional study that did not include intervention follow-up as done in recent studies in Cote d'Ivoire 6,28 -further longitudinal studies of treatment impact on iron metabolism and anemia will be welcome to identify optimal treatment and prevention strategies for parasitic infection and anemia among preschool children in parasite-endemic areas.…”

Section: Discussionmentioning

confidence: 99%

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Anemia Among Children Exposed to Polyparasitism in Coastal Kenya

Cojulun

Bustinduy

Sutherland

et al. 2015

The American Society of Tropical Medicine and Hygiene

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Abstract. Anemia represents a substantial problem for children living in areas with limited resources and significant parasite burden. We performed a cross-sectional study of 254 Kenyan preschool-and early school-age children in a setting endemic for multiple chronic parasitic infections to explore mechanisms of their anemia. Complete venous blood cell counts revealed a high prevalence of local childhood anemia (79%). Evaluating the potential links between low hemoglobin and socioeconomic factors, nutritional status, hemoglobinopathy, and/or parasite infection, we identified age < 9 years (odds ratio [OR]: 12.0, 95% confidence interval [CI]: 4.4, 33) and the presence of asymptomatic malaria infection (OR: 6.8, 95% CI: 2.1, 22) as the strongest independent correlates of having anemia. A total of 130/155 (84%) of anemic children with iron studies had evidence of iron-deficiency anemia (IDA), 16% had non-IDA; 50/52 of additionally tested anemic children met soluble transferrin-receptor (sTfR) criteria for combined anemia of inflammation (AI) with IDA. Children in the youngest age group had the greatest odds of iron deficiency (OR: 10.0, 95% CI: 3.9, 26). Although older children aged 9-11 years had less anemia, they had more detectable malaria, Schistosoma infection, hookworm, and proportionately more non-IDA. Anemia in this setting appears multifactorial such that chronic inflammation and iron deficiency need to be addressed together as part of integrated management of childhood anemia.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Anemia Among Children Exposed to Polyparasitism in Coastal Kenya

Cojulun

Bustinduy

Sutherland

et al. 2015

The American Society of Tropical Medicine and Hygiene

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“…Mean sTfR concentration obtained in the current study compares well with findings from studies that have used the Ramco sTfR kit (42)(43)(44)(45) . Serum sTfR concentration does not appear to be affected by infectious or inflammatory conditions (46) except for malaria, which in some studies has been observed to increase sTfR levels (47)(48)(49) while in at least one other study caused a decrease in sTfR (50) . We did not find any difference in sTfR levels by malaria status or by infection/ inflammation (data not shown).…”

Section: Discussionmentioning

confidence: 99%

The aetiology of anaemia during pregnancy: a study to evaluate the contribution of iron deficiency and common infections in pregnant Ugandan women

Baingana

Enyaru

Tjalsma

et al. 2014

Public Health Nutr.

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Objective: To describe the aetiology of anaemia in pregnant Ugandan women and explore Fe deficiency and common infections as contributors to anaemia in this population. Design: Cross-sectional study in which Hb, ferritin, transferrin receptor (sTfR), C-reactive protein, α-1 acid glycoprotein, hepcidin, malaria, hookworm infestation, syphilis and Helicobacter pylori infection were assessed. Setting: Antenatal care clinic at Kawempe Health Centre, Kampala, Uganda. Subjects: HIV-negative women (n 151) in their first or second pregnancy at 10-16 weeks' gestation. Results: The prevalence of anaemia was 29·1 %. Fe deficiency was 40·4 % and 14·6 % based on ferritin <30 μg/l and on adjusted ferritin <12 μg/l respectively, and 6·6 % based on sTfR >8·3 μg/ml. The prevalence of Fe-deficiency anaemia was 9·3 % based on ferritin <30 μg/l, 6·6 % based on adjusted ferritin <12 μg/l and 4·3 % based on sTfR >8·3 μg/ml. Hepcidin concentration was positively correlated with ferritin concentration (n 151, r = 0·578, P < 0·00001). H. pylori infection was highly prevalent (70 %) while malaria, hookworm infestation and syphilis were not common. Of all women, 60·3 % had α-1 acid glycoprotein >1 g/l and/or C-reactive protein >5 mg/l. Malaria parasitaemia (OR = 6·85; 95 % CI 1·25, 37·41, P = 0·026) and Fe deficiency defined using sTfR (OR = 5·58; 95 % CI 1·26, 24·80, P = 0·024) were independently and positively associated with anaemia. Populationattributable risk factors for anaemia for raised C-reactive protein, Fe deficiency defined by sTfR >8·3 μg/ml and presence of malaria parasites were 41·6 (95 % CI 11·1, 72·2) %, 13·5 (95 % CI 2·0, 25·0) % and 12·0 (95 % CI 1·4, 22·6) %, respectively. Conclusions: Infections and inflammation are of greater significance than Fe deficiency in the aetiology of anaemia in pregnant Ugandan women during the first trimester. Keywords Anaemia Iron status Pregnancy Infection UgandaNearly 25 % of the world's population suffers from anaemia, with pregnant women and children of pre-school age the most affected (1) . In Uganda, anaemia is the third leading cause of in-patient mortality (2) . In 2011, 49 % of under-fives, 23 % of women of child-bearing age and 31 % of pregnant women in Uganda had anaemia (3) . Anaemia in developing countries has a multifactorial aetiology which includes Fe deficiency (ID) due to dependence on predominantly plant-based diets from which adequate Fe cannot be absorbed (4,5) . Infections such as malaria and hookworm infestation also contribute significantly to the high prevalence of anaemia in many settings (6) . Additionally, infection and inflammation defined by raised biomarkers contribute to anaemia as was demonstrated in a study in Malawi in which C-reactive protein (CRP) was elevated in 73·5 % of anaemic pregnant women who were Fe-replete by bone marrow assessment (7) . Hinderaker et al. (8) also found an association between elevated CRP and anaemia in pregnant women in rural Tanzania. More recently, Helicobacter pylori, the most common infection globally, has been

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“…sTfR 60 is believed to be less affected by inflammation (4), although there are discrepancies in the 61 literature regarding the relationship between inflammation, infection and sTfR. Some studies 62 have shown that sTfR decreased in presence of inflammation (6,7) and malaria (8) while others 63 found higher levels of sTfR in individuals with malaria (9,10) or observed positive 64 relationships between inflammation markers and sTfR (10)(11)(12)(13)(14). It is unclear what causes these Plasmodium falciparum malaria parasite (Bioline, Malaria Ag P.f, Standard diagnostics Inc.) 124 and one drop of blood was used to estimate haemoglobin concentration using a HemoCue 125 device (HB 301, Ängelholm, Sweden).…”

mentioning

confidence: 92%

“…However, while in the case of SF it makes sense to pick the best performing 306 model for adjustment, this may not be the case for sTfR. As previously mentioned there is still 307 some debate as to whether sTFR should be adjusted for inflammation (10,(21)(22)(23) and there are while erythropoietin is increased in malaria (35,36), the bone marrow response to 318 erythropoietin may be suppressed until parasites have been cleared (36). We measured malaria 319 using an rapid diagnostic test, which can stay positive for over a month following treatment 320 (37,38) so it is not possible to know whether a positive test reflects current or recent malaria.…”

mentioning

confidence: 98%