Overview of the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) Project

Abstract

Anemia remains a widespread public health problem. Although iron deficiency is considered the leading cause of anemia globally, the cause of anemia varies considerably by country. To achieve global targets to reduce anemia, reliable estimates of the contribution of nutritional and non-nutritional causes of anemia are needed to guide interventions. Inflammation is known to affect many biomarkers used to assess micronutrient status and can thus lead to incorrect diagnosis of individuals and to overestimation or underestimation of the prevalence of deficiency in a population. Reliable assessment of iron status is particularly needed in settings with high infectious disease burden, given the call to screen for iron deficiency to mitigate potential adverse effects of iron supplementation. To address these information gaps, in 2012 the CDC, National Institute for Child Health and Human Development, and Global Alliance for Improved Nutrition formed a collaborative research group called Biomarkers Reflecting Inflammation and Nutrition Determinants of Anemia (BRINDA). Data from nationally and regionally representative nutrition surveys conducted in the past 10 y that included preschool children and/or women of childbearing age were pooled. Of 25 data sets considered for inclusion, 17 were included, representing ∼30,000 preschool children, 26,000 women of reproductive age, and 21,000 school-aged children from all 6 WHO geographic regions. This article provides an overview of the BRINDA project and describes key research questions and programmatic and research implications. Findings from this project will inform global guidelines on the assessment of anemia and micronutrient status and will guide the development of a research agenda for future longitudinal studies.

Iron status of toddlers, nonpregnant females, and pregnant females in the United States

“…Furthermore, the exclusion approach relies on established cutoffs for inflammation and thus may not capture the full spectrum of inflammation in a population, especially in low-infection settings such as the United States. The recommended analytic approach from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) group, regarding adjusting for inflammation, is to use regression correction to adjust sTfR by using AGP (27,31) and to correct SF by using both AGP and CRP (32). Unfortunately, AGP is not collected in NHANES, limiting our ability to adjust the ID and IDA estimates for inflammation.…”

Safety and benefits of antenatal oral iron supplementation in low‐income countries: a review

“…These are used together with ferritin to exclude inflamed individuals from analysis or to alter the cut‐off of ferritin used to define deficiency. Recently, the Biomarkers Reflecting Inflammation and Nutrition Determinants of Anaemia (BRINDA) project proposed possible methods to address inflammation and other potential confounders of ferritin (Suchdev et al , 2016). The quantitative assessment of circulating concentrations of CRP and AGP allows for adjustment of ferritin concentration for the effect of inflammation (Suchdev et al , 2016; Thurnham & Northrop‐Clewes, 2016).…”

“…Recently, the Biomarkers Reflecting Inflammation and Nutrition Determinants of Anaemia (BRINDA) project proposed possible methods to address inflammation and other potential confounders of ferritin (Suchdev et al , 2016). The quantitative assessment of circulating concentrations of CRP and AGP allows for adjustment of ferritin concentration for the effect of inflammation (Suchdev et al , 2016; Thurnham & Northrop‐Clewes, 2016). In addition, point‐of‐care tests are rapidly developing, with quantitative tests already being commercially available for circulating concentrations of ferritin and C‐reactive protein.…”

Assessment of Neurodevelopment, Nutrition, and Inflammation From Fetal Life to Adolescence in Low-Resource Settings

“…7,47,87,91 To address these challenges in the assessment of nutrition status, a collaborative research group called Biomarkers Reflecting Inflammation and Nutrition Determinants of Anemia has been formed to pool and analyze data from populationbased nutrition surveys and answer priority research questions related to the assessment of micronutrient status in settings of inflammation. 79 Preliminary findings suggest a strong relationship between CRP and AGP and both iron (ferritin, soluble transferrin receptor) and vitamin A (retinol binding protein) biomarkers. A recommended statistical approach to account for the confounding effects of inflammation on these nutrient biomarkers is being developed.…”

“…78 AGP has been used as a measure of chronic or longer-term exposure to inflammation, but there is some uncertainty as to the threshold that defines "elevated" AGP, especially in relation to the interpretation of nutrition biomarkers. 79 Tissue-specific inflammatory biomarkers can also assess inflammation locally. For example, in addition to direct assessment of small or large intestinal histopathology or special staining of inflammatory cell subtypes or of tight junction disruption, intestinal inflammation as well as intestinal barrier disruption can be measured by using any of a number of fecal and other biomarkers.…”