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Inflammation and infections such as malaria affect estimates of micronutrient status. Medline, Embase, Web of Science, Scopus and the Cochrane library were searched to identify studies reporting mean concentrations of ferritin, hepcidin, retinol or retinol binding protein in individuals with asymptomatic or clinical malaria and healthy controls. Study quality was assessed using the United States National Institute of Health tool. Random-effects meta-analyses were used to generate summary mean differences. In total, 44 studies were included. Mean ferritin concentrations were elevated by: 28.2 µg/L (95%CI: 15.6, 40.9) in children with asymptomatic malaria, 28.5 µg/L (95%CI: 8.1, 48.8) in adults with asymptomatic malaria, and 366 µg/L (95%CI: 162, 570) in children with clinical malaria compared to individuals without malaria infection. Mean hepcidin concentrations were elevated by 1.52 nmol/L (95%CI: 0.92, 2.11) in children with asymptomatic malaria. Mean retinol concentrations were reduced by: 0.11 µmol/L (95%CI: −0.22, −0.01) in children with asymptomatic malaria, 0.43 µmol/L (95%CI: −0.71, −0.16) in children with clinical malaria and 0.73 µmol/L (95%CI: −1.11, −0.36) in adults with clinical malaria. Most of these results were stable in sensitivity analyses. In children with clinical malaria and pregnant women, difference in ferritin concentrations were greater in areas with higher transmission intensity. We conclude that biomarkers of iron and vitamin A status should be statistically adjusted for malaria and the severity of infection. Several studies analysing asymptomatic infections reported elevated ferritin concentrations without noticeable elevation of inflammation markers, indicating a need to adjust for malaria status in addition to inflammation adjustments.

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Background and aimsIndia is the world's third largest contributor to greenhouse gas (GHG) emissions and the world's largest user of groundwater. This is not only due to its large population but also the rapid pace of development and dietary change, which has resulted in diverse diets being consumed by different population groups. This study aimed to quantify the GHG emissions in carbon dioxide equivalent (CO2e) and water usage in litres (L) associated with typical dietary patterns in India.MethodsThe GHG emissions and water use of five typical and distinct dietary patterns were quantified using estimates taken from previous studies, and based on the LCA model for GHG emissions and the Water Footprint (WF) Assessment for water use. The dietary patterns were identified from the Indian Migration Study (IMS), a large adult population sample in India, and were named on the basis of the dominant staple grain and one other identifying feature: Rice & low energy, Rice & fruit, Wheat & pulses, Wheat, rice & oils, Rice & meat. Mixed effects regression models were used to quantify the change in environmental impacts that would occur for individuals switching between dietary patterns.ResultsOverall across all dietary patterns, the GHG emissions from Indian diets were 3.6kg CO2e/capita/day (mean ± standard deviation), the green WF (from precipitation) was 2,531L/capita/day and the blue WF (from ground and surface water) was 737L/capita/day. However, there was substantial variability between dietary patterns: the rice‐based patterns had higher GHG emissions and green WFs per calorie, while the wheat‐based patterns had slightly higher blue WFs per calorie. Switching from the Rice & low energy diet to the Rice & meat pattern would result in a 0.59kg (15%) increase in GHG emissions, a 536L (24%) increase in green WF and a 109L (19%) increase in blue WF. By contrast, switching to the Wheat, rice & oils pattern would result in a 0.82kg (20%) decrease in GHG emissions and a 364L (17%) decrease in green WF, but a 302L (53%) increase in blue WF.DiscussionThese are the first estimates of environmental impacts from distinct dietary patterns in India. Overall, Indian diets were lower in both GHG emissions and green WFs although higher in blue WFs than diets in high income countries. However, the rice‐based patterns were found to have much higher environmental impacts than the wheat‐based patterns. As Indian diets continue to transition, it is likely that more people will switch their diets from the most traditional pattern identified (the Rice & low energy) pattern to one of the other rice‐ or wheat‐based patterns. Switching to one of the wheat‐based patterns identified would reduce dietary GHG emissions and green WF, but increase blue WF, which may not be desirable in a country already suffering groundwater shortages. Future policies on food will need to balance the various environmental impacts of different diets as well as the possible health implications, and may also need to take into account regional variations in both environmental conditions and cultural diet preferences.Support or Funding InformationThe study was funded by the Wellcome Trust Our Planet, Our Health Programme (Grant number 103932).

Population-level assessment of zinc deficiency remains a challenge due to the lack of suitable biomarkers. Spot urinary zinc concentration (UZC) has the potential to provide information on population zinc status in large-scale surveys, but there is no established cut-off point indicating deficiency. A strong correlation between this biomarker and an established biomarker such as serum zinc concentration (SZC) in paired samples (i.e., from the same individual), could identify the thresholds indicating zinc deficiency. This study, therefore, aimed to regress spot UZC from school-aged children and women from the Malawi micronutrient survey with paired SZC data using a linear mixed-effects model. The nested variance components indicated no linear relationship between the UZC and SZC data, irrespective of adjustments for inflammation and hydration. Thresholds of urinary zinc excretion that have been suggested by expert panels were applied to the spot UZC data, as a post-hoc analysis. The zinc deficiency prevalence estimates derived from these suggested thresholds were not similar to the estimates from the SZC data, and further research is required to understand whether spot UZC can still provide useful information in population zinc assessment.