The effect of inflammation on serum zinc concentrations and the prevalence estimates of population-level zinc status among Congolese children aged 6–59 months

Karakochuk, Crystal D; Barr, Susan I.; Boy, Erick; Bahizire, Esto; Tugirimana, Pierrot Lundimu; Akilimali, Pierre; Houghton, Lisa A; Green, Timothy

doi:10.1038/ejcn.2017.127

Cited by 17 publications

(16 citation statements)

References 13 publications

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“…The risk of zinc deficiency was thus poorly predicted by stunting in most of these surveys. Individual studies have not been able to determine direct relationships between SZC and stunting using different approaches [ 14 , 50 , 51 , 52 ].…”

Section: Discussionmentioning

confidence: 99%

“…Several methods can be used to control for the effects of inflammation when reporting results of APR nutrients. The two most widely recommended methods use mathematical calculations to adjust the micronutrient concentrations [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. These methods are reliant on an individuals’ inflammation status, with inflammatory markers being measured at the same time as the micronutrient.…”

Section: Introductionmentioning

confidence: 99%

“…It was developed by the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project, and is referred to as the BRINDA method [ 19 ]. Studies have shown that both methods can adjust concentrations of different micronutrients [ 11 , 13 , 18 , 20 , 21 , 22 , 23 , 24 , 25 ] and more specifically, concentrations of zinc in PSC [ 14 , 15 ], adults [ 16 ], and the elderly [ 12 ]. Currently, no studies have applied these methods, to adjust for zinc deficiency in a nationally representative sample of all age and gender groups.…”

Section: Introductionmentioning

confidence: 99%

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Inflammation Adjustment by Two Methods Decreases the Estimated Prevalence of Zinc Deficiency in Malawi

et al. 2020

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Serum zinc concentration (SZC) is used widely to assess population-level zinc status. Its concentration decreases during inflammatory responses, which can affect the interpretation of the results. This study aimed to re-estimate the prevalence of zinc deficiency in Malawi based on the 2015–2016 Malawi Micronutrient Survey (MNS) data, by adjusting SZC measures with markers of inflammation. SZC and inflammation data from 2760 participants were analysed. Adjustments were made using: (1) The Internal Correction Factor (ICF) method which used geometric means, and (2) The Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) method, which used linear regression. Mean SZC values increased significantly when adjustments were made by either ICF or BRINDA (p < 0.001). The national prevalence of zinc deficiency decreased from 62% to 59%, after ICF adjustment, and to 52% after BRINDA adjustment. ICF and BRINDA values of SZC were highly correlated (p < 0.001, r = 0.99), but a Bland–Altman plot showed a lack of agreement between the two methods (bias of 2.07 µg/dL). There was no association between the adjusted SZC and stunting, which is a proxy indicator for zinc deficiency. Inflammation adjustment of SZC, using ICF or BRINDA, produces lower estimates of zinc deficiency prevalence, but the lack of agreement between the adjustment methods warrants further research. Furthermore, the lack of association between SZC and stunting highlights the need to explore other biomarkers and proxies of population zinc assessment. This study demonstrates the importance of considering inflammatory confounders when reporting SZC, to ensure accuracy and to support policy decision making.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Inflammation Adjustment by Two Methods Decreases the Estimated Prevalence of Zinc Deficiency in Malawi

et al. 2020

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“…Previously, sTfR and zinc were not considered to be influenced by inflammation on the basis that they were not acute phase proteins like ferritin. However, several reports have described inflammatory-induced changes in sTfR [22, 45–48] and zinc [49–52] thereby suggesting an alternative influence of the inflammatory response [53–55]…”

Section: Discussionmentioning

confidence: 99%

Multiple micronutrient status and predictors of anemia in young children aged 12-23 months living in New Delhi, India

et al. 2019

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Anemia has been identified as a severe public health concern among young children in India, however, information on the prevalence of anemia attributed to micronutrient deficiencies is lacking. We aimed to assess multiple micronutrient status (iron, zinc, selenium, vitamin A, vitamin D, folate and vitamin B12) in young Indian children and to investigate the role of these seven micronutrients and other non-nutritional factors on hemoglobin concentrations and anemia. One-hundred and twenty children aged 12 to 23 months were included in a cross-sectional nutritional assessment survey, of which 77 children provided a blood sample. Hemoglobin (Hb), serum ferritin, soluble transferrin receptor (sTfR), total body iron, zinc, selenium, retinol binding protein (RBP), folate, vitamin B12 and 25-hydroxyvitamin D (25(OH)D) were measured, and adjusted for inflammation using C-reactive protein (CRP) and α-1-acid glycoprotein (AGP), where appropriate. Predictors for hemoglobin and anemia were identified in multiple regression models. Most of the children were classified as anemic, of which 86 to 93% was associated with iron deficiency depending on the indicator applied. Deficiencies of folate (37%), and notably vitamin D (74%) were also common; fewer children were classified with deficiencies of vitamin B12 (29%), zinc (25%), and vitamin A (17%) and selenium deficiency was nearly absent. Multiple micronutrient deficiencies were common with over half (57%) deficient in three or more micronutrients, and less than 10% of children were classified with adequate status for all the micronutrients measured. Iron status was found to be the only nutritional factor statistically significantly inversely associated with anemia (P = 0.003) in multivariate analysis after controlling for sex. A coordinated multi-micronutrient program is urgently needed to combat the co-existing micronutrient deficiencies in these young children to improve micronutrient status and reduce the high burden of childhood anemia.

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“…Second, even though women who were going through any type of clinical infection or disease were excluded from the study, we did not assess any inflammatory marker, such as alpha 1 glycoprotein, C-reactive protein and interleukin-6; that would allow exclusion of women with an inflammatory process that could be related to decreased PZn [ 39 , 40 ]. It is also important to note that postpartum women, in general, have a more active immune system and higher serum levels of proinflammatory cytokines, and it is somewhat more active among breastfeeding than formula-feeding women [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Zinc Deficiency among Lactating Mothers from a Peri-Urban Community of the Ecuadorian Andean Region: An Initial Approach to the Need of Zinc Supplementation

et al. 2018

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Zinc is an important mineral for biological and physiological processes. Zinc deficiency (ZD) is one of the most common micronutrient deficiencies worldwide and a crucial determinant of pregnancy outcomes and childhood development. Zinc levels and the zinc supplementation rate among lactating women have not been assessed neither in Ecuador nor in the Andean region. We conducted a pilot study including 64 mothers of infants between eight days to seven months old from a primary care center located in Conocoto, a peri-urban community of Quito, Ecuador. The mothers were interviewed and a fasting blood sample was taken to determine plasma zinc levels. The prevalence of ZD was calculated and compared with the prevalence of ZD among Ecuadorian non-pregnant non-lactating women, and the sample was analysed considering zinc supplementation during pregnancy. The prevalence of ZD among the participants was 81.3% (95% CI: 71.7–90.9), higher than the reported among non-pregnant non-lactating women (G2 = 18.2; p < 0.05). Zinc supplementation rate was 31.2%. No significant differences were found comparing the groups considering zinc supplementation. The insights obtained from this study encourage extending studies to document zinc levels and its interactions among breastfeeding women in areas with a high prevalence of ZD in order to determine the need of zinc supplementation.

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The effect of inflammation on serum zinc concentrations and the prevalence estimates of population-level zinc status among Congolese children aged 6–59 months

Abstract: Adjustment of zinc concentrations for inflammation is warranted when assessing population-level zinc status.European Journal of Clinical Nutrition advance online publication, 23 August 2017; doi:10.1038/ejcn.2017.127.

Cited by 17 publications

References 13 publications

Inflammation Adjustment by Two Methods Decreases the Estimated Prevalence of Zinc Deficiency in Malawi

Inflammation Adjustment by Two Methods Decreases the Estimated Prevalence of Zinc Deficiency in Malawi

Multiple micronutrient status and predictors of anemia in young children aged 12-23 months living in New Delhi, India

Zinc Deficiency among Lactating Mothers from a Peri-Urban Community of the Ecuadorian Andean Region: An Initial Approach to the Need of Zinc Supplementation

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