Potential magnitude of the misclassification of a population's trace element status due to infection: example from a survey of young Peruvian children

Abstract

To examine the effects of concurrent infection on population-based assessment of trace element status, we collected data on clinical signs and laboratory indicators of infection when obtaining blood for serum zinc, copper, and ferritin analyses in 153 Peruvian children aged 11-19 mo. Fifty-two (34.7%) of the children had some reported sign of infection and 43 (28.3%) had elevated C-reactive protein concentrations or leukocytosis. Children with any evidence of infection had marginally lower mean (+/- SD) serum zinc concentrations (7.0 +/- 2.3 vs 7.5 +/- 2.0 mumol/L, P = 0.16) and significantly greater serum copper (24.7 +/- 4.7 vs 22.7 +/- 4.2 mumol/L, P = 0.006) and serum ferritin concentrations (10.0 +/- 12.9 vs 3.9 +/- 4.4 micrograms/L, P < 0.001) than did those without infections. Infection caused an underestimation in the rate of low copper status by 1 percentage point and low iron status by 12 percentage points. Thus, the effect of concurrent infections is of variable magnitude and may differ by nutrient, nutritional status of the population, and prevalence and severity of infections.

Iron status of middle-aged women in five counties of rural China

“…C-reactive protein, ceruloplasmin, and retinol are acute-phase respondents and were signi®cantly altered from the normal or depleted quadrants. These subjects may have sustained an in¯ammatory response during the previous 4 ± 6 weeks from a vaccination (Olivares et al, 1993), an acute infection (Brown et al, 1993) such as acute pneumonia (Baynes et al, 1986), or they may have had a chronic in¯ammatory condition such as rheumatoid arthritis (Ahluwalia et al, 1995).…”

Nutrition Guidelines for HIV-infected Adults and Children in Southern Africa

“…23 Severe wasting in adults is defined by the CDC as a body mass index (BMI) < 18.5 (kg/m) 2 or unintentional weight loss of > 5% of usual body weight within 6 months. 24 Growth faltering and stunting are common in children with HIV infection and occur early in life. [25][26][27] In children, wasting is particularly associated with the loss of lean body mass and failure to gain height.…”

“…27 In adults both lean mass and fat are lost, though the loss of lean mass predominates. 24 In contrast, starvation leads primarily to fat loss. 24 Both the loss of lean mass and poor linear growth in HIV-infected children are closely associated with poor survival and protecting lean body mass prolongs survival.…”

Micronutrients and HIV infection: a review

“…Therefore, while infections reduce micronutrient status per se, it may also independently affect serum levels of the quantities used to assess status (Filteau & Tomkins, 1994), and give raise to misclassi®cation of micronutrient status (Brown et al, 1993). Thus, it is necessary to distinguish between micronutrient status and level.…”