Adjusting Ferritin Concentrations for Nonclinical Inflammation in Adolescents with Overweight or Obesity

Pompano, Laura M; Correa, Juana P.; Burrows, Raquel; Blanco, Estela; Lozoff, Betsy; Gahagan, Sheila

doi:10.1016/j.jpeds.2022.01.012

Cited by 3 publications

(2 citation statements)

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“…In 2020, the WHO revised their guidance on the use of ferritin to assess iron status in individuals and populations, providing thresholds of <15 µg/L for healthy individuals above 5 years of age and <70 µg/L for individuals with infection or inflammation (<12 µg/L or <30 µg/L are used for children under 5). While current WHO guidance is that ferritin, both an iron storage protein and an acute phase reactant associated with inflammation,43 should not be used alone to diagnose ID without other iron profile biomarkers or corrections for inflammation,44 a minority of studies did rely on ferritin alone 25 45–48. Likewise, serum iron alone should not be used in isolation to diagnose ID as serum iron levels will be reduced in the context of infection or inflammation,49 but was used in a handful of studies 43 50 51.…”

Section: Resultsmentioning

confidence: 99%

“…Inflammatory status is particularly relevant as ferritin, the primary blood biomarker of iron status used, was consistently found higher in obese groups compared with children with normal weight, with direct linear association reported in multiple studies 25 46–49 56 66 85 98–105. However, as ferritin is an acute phase reactant, inflammation can obscure ID106.…”

Section: Discussionmentioning

confidence: 99%

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Overnutrition is a risk factor for iron, but not for zinc or vitamin A deficiency in children and young people: a systematic review and meta-analysis

Tan,

Gong

et al. 2024

BMJ Glob Health

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IntroductionTraditionally associated with undernutrition, increasing evidence suggests micronutrient deficiencies can coexist with overnutrition. Therefore, this work aimed to systematically review the associations between iron, zinc and vitamin A (VA) status and weight status (both underweight and overweight) in children and young people.MethodsOvid Medline, Ovid Embase, Scopus and Cochrane databases were systematically searched for observational studies assessing micronutrient status (blood, serum or plasma levels of iron, zinc or VA biomarkers) and weight status (body mass index or other anthropometric measurement) in humans under 25 years of any ethnicity and gender. Risk of bias assessment was conducted using the American Dietetic Association Quality Criteria Checklist. Where possible, random effects restricted maximum likelihood meta-analyses were performed.ResultsAfter screening, 83 observational studies involving 190 443 participants from 44 countries were identified, with many studies having reported on more than one micronutrient and/or weight status indicator. Iron was the most investigated micronutrient, with 46, 28 and 27 studies reporting data for iron, zinc and VA status, respectively. Synthesising 16 records of OR from seven eligible studies, overnutrition (overweight and obesity) increased odds of iron deficiency (ID) (OR (95% CI): 1.51 (1.20 to 1.82), p<0.0001, I2=40.7%). Odds appeared to be higher for children living with obesity (1.88 (1.33 to 2.43), p<0.0001, I2=20.6%) in comparison to those with overweight (1.31 (0.98 to 1.64), p<0.0001, I2=40.5%), although between group differences were not significant (p=0.08).ConclusionsOvernutrition is associated with increased risk of ID, but not zinc or VA deficiencies, with an inverted U-shaped relationship observed between iron status and bodyweight. Our results highlight significant heterogeneity in the reporting of micronutrient biomarkers and how deficiencies were defined. Inflammation status was rarely adequately accounted for, and the burden of ID may well be under-recognised, particularly in children and young people living with overnutrition.PROSPERO registration numberCRD42020221523.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Overnutrition is a risk factor for iron, but not for zinc or vitamin A deficiency in children and young people: a systematic review and meta-analysis

Tan,

Gong

et al. 2024

BMJ Glob Health

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Population Iron Status in Canada: Results from the Canadian Health Measures Survey 2012–2019

Cooper¹,

Bertinato²,

Ennis³

et al. 2023

The Journal of Nutrition

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Overnutrition is a risk factor for iron deficiency in children and young people: a systematic review and meta-analysis of micronutrient deficiencies and the double burden of malnutrition

Tan,

Gong

et al. 2024

Preprint

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IntroductionTraditionally associated with undernutrition, increasing evidence suggests micronutrient deficiencies can co-exist with overnutrition. Therefore, this work aimed to systematically review the associations between iron, zinc and vitamin A status and weight status (both under- and overweight) in children and young people.MethodsOvid Medline, Ovid Embase, Scopus, and Cochrane databases were systematically searched for observational studies assessing micronutrient status (blood, serum, or plasma levels of iron, zinc, or vitamin A biomarkers) and weight status (body mass index or other anthropometric measurement) in humans under 25 years of any ethnicity and gender. Risk of bias assessment was conducted using the American Dietetic Association Quality Criteria Checklist. Where possible, random effects restricted maximum likelihood (REML) meta-analyses were performed. PROSPERO (CRD42020221523).ResultsAfter screening, 83 observational studies involving 190,443 participants from 44 countries were identified, with many studies having reported on more than one micronutrient and/or weight status indicator. Iron was the most investigated micronutrient, with 46, 28, and 27 studies reporting data for iron, zinc, and vitamin A status, respectively. Synthesizing 16 records of odds ratio (OR) from 7 eligible studies, overnutrition (overweight and obesity) increased odds of iron deficiency (OR [95%CI]: 1.51 [1.20, 1.82], p<0.0001, I2=40.7%). Odds appeared to be higher for children living with obesity (1.88 [1.33, 2.43], p<0.0001 I2=20.6%) in comparison to those with overweight (1.31 [0.98, 1.64], p<0.0001 I2=40.5%), although between group differences were not significant (p=0.08).ConclusionsOvernutrition is associated with increased risk of iron deficiency, but not zinc or vitamin A deficiencies, with an inverted U-shaped relationship observed between iron status and bodyweight. Our results highlight significant heterogeneity in the reporting of micronutrient biomarkers and how deficiencies were defined. Inflammation status was rarely adequately accounted for, and the burden of iron deficiency may well be under-recognised, particularly in children and young people living with overnutrition.Key questionsWhat is already known on this topic-summarise the state of scientific knowledge on this subject before you did your study and why this study needed to be doneLow-and middle-income countries are increasingly facing a double burden of malnutrition; that is, the coexistence of undernutrition (stunting, wasting, underweight) with overnutrition (overweight and obesity).While the relationship between undernutrition and critical micronutrients for childhood growth and development (e.g., iron, zinc, and vitamin A) is well established, less is known about the risk of micronutrient deficiencies in children and adolescents with overweight or obese, a hidden form of malnutrition.There are limited data summarising associations between biomarkers of the most commonly limiting micronutrients and body weight status, particularly in children and young people.What this study adds-summarise what we now know as a result of this study that we did not know beforeOvernutrition increases the risk of iron deficiency, but not zinc or vitamin A deficiencies.There is an inverted U-shaped relationship observed between iron status and bodyweight in children and young people, with iron deficiencies observed more frequent in both under- and overnutrition.Studies done to date have been heterogeneous in terms of populations studied, diagnostic criteria, and approaches to data analysis; few followed current guidelines for measuring inflammation and defining micronutrient deficiencies.How this study might affect research, practice or policy-summarise the implications of this studyIncreased recognition by healthcare practitioners that children and young people living with overweight, or obesity are likely to be iron deficient; thereby improving clinical practice and care.The gaps in evidence highlighted are addressed, with more research from currently underrepresented counties examining micronutrient deficiencies and the double burden of malnutrition.The weaknesses in study design and reporting highlighted are addressed, with improved quality and reporting of micronutrient assessment in children and young people.

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Adjusting Ferritin Concentrations for Nonclinical Inflammation in Adolescents with Overweight or Obesity

Cited by 3 publications

References 20 publications

Overnutrition is a risk factor for iron, but not for zinc or vitamin A deficiency in children and young people: a systematic review and meta-analysis

Overnutrition is a risk factor for iron, but not for zinc or vitamin A deficiency in children and young people: a systematic review and meta-analysis

Population Iron Status in Canada: Results from the Canadian Health Measures Survey 2012–2019

Overnutrition is a risk factor for iron deficiency in children and young people: a systematic review and meta-analysis of micronutrient deficiencies and the double burden of malnutrition

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