Adjusting iron and vitamin A status in settings of inflammation: a sensitivity analysis of the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) approach

Namasté, Sorrel; Ou, Jiangda; Williams, Anne; Young, Melissa; Yu, Emma X; Suchdev, Parminder S.

doi:10.1093/ajcn/nqaa141

Cited by 23 publications

(31 citation statements)

References 30 publications

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“…The highest infl ammation rates diagnosed by AGP have been reported in Asian and African countries by the BRINDA study. [23] Nonetheless, even though high CRP levels were found only in about 10% of children in the study, some had concentrations much higher than the cut-off point. Chronic infl ammation, assessed by AGP, is associated with a higher frequency of obesity and asthma in children [18] and high CRP values are associated with systemic bacterial infections, tissue damage and allergies.…”

Section: Discussionmentioning

confidence: 66%

Influence of Inflammation on Assessing Iron-Deficiency Anemia in Cuban Preschool Children

Pita-Rodríguez¹,

Chávez-Chong²,

Lambert-Lamazares³

et al. 2021

MEDICC Review

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INTRODUCTION Anemia is a public health problem worldwide and is most prevalent in preschool children, for whom it is the most frequent cause of nutritional defi cits. In turn, iron defi ciency is the main cause of anemia, affecting 43% of children globally. Previous studies in Cuba show rates of iron defi ciency in preschool children between 38.6% and 57.6%, higher in infants (71.2% to 81.1%). WHO recommends using serum ferritin as an indicator of iron defi ciency accompanied by acute (C-reactive protein) and chronic (α1-acid glycoprotein) infl ammation biomarkers. OBJECTIVE Assess how infl ammation affects measuring and reporting of iron-defi ciency anemia rates in Cuban preschool children.METHODS Data were obtained from serum samples contained in the National Anemia and Iron Defi ciency Survey, and included presumably healthy preschool Cuban children (aged 6-59 months). Serum samples were collected from 1375 children from randomly selected provinces in 4 regions of the country from 2014 through 2018. We examined the association between ferritin and two infl ammatory biomarkers: C-reactive protein and α1-acid glycoprotein. Individual infl ammation-adjusted ferritin concentrations were calculated using four approaches: 1) a higher ferritin cut-off point (<30 g/L); 2) exclusion of subjects showing infl ammation (C-reactive protein >5 mg/L or α1-acid glycoprotein >1 g/L); 3) mathematical correction factor based on C-reactive protein or α1-acid glycoprotein; and 4) correction by regression with the method proposed by the Biomarkers Refl ecting Infl ammation and Nutritional Determinants of Anemia Group. We estimated confi dence intervals of differences between unadjusted prevalence and prevalence adjusted for infl ammation by each method. RESULTSThe proportion of children with infl ammation according to C-reactive protein concentrations >5 mg/L was lower (11.1%, 153/1375) than the proportion measured according to the concentrations of α1-acid glycoprotein, at >1 g/L (30.8%, 424/1375). The percentage of children with high concentrations of at least one of the aforementioned biomarkers was 32.7% (450/1375). Thus, each correction method increased the observed prevalence of iron defi ciency compared to unadjusted estimates (23%, 316/1375). This increase was more pronounced when using the internal regression correction method (based only on C-reactive protein) or the method based on a higher cut-off point. Adjustment using all four methods changed estimated iron defi ciency prevalence, increasing it from 0.1% to 8.8%, compared to unadjusted values. CONCLUSION One-third of preschool children had biomarkers indicating elevated infl ammation levels. Without adjusting for infl ammation, iron defi ciency prevalence was underestimated. The signifi cant disparity between unadjusted and infl ammationadjusted ferritin when using some approaches highlights the importance of selecting the right approach for accurate, corrected measurement. The internal regression correction approach is appropriate for epidemiological studies because...

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Section: Discussionmentioning

confidence: 66%

Influence of Inflammation on Assessing Iron-Deficiency Anemia in Cuban Preschool Children

Pita-Rodríguez¹,

Chávez-Chong²,

Lambert-Lamazares³

et al. 2021

MEDICC Review

View full text Add to dashboard Cite

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“…In 2017, researchers from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project published a new mathematical method to estimate the prevalence of iron and vitamin A in settings of acute and chronic inflammation [ 47 ]. They suggested that without this adjustment, iron deficiency could be under-reported and vitamin A and zinc deficiency could be over-reported [ 47 , 48 , 49 ]. Nevertheless, it is unclear if the results of this study can be used in individuals.…”

Section: Discussionmentioning

confidence: 99%

Micronutrient Deficiencies in Patients with Decompensated Liver Cirrhosis

et al. 2021

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Patients with cirrhosis often develop malnutrition and micronutrient deficiencies, leading to a worse prognosis and increased mortality. Our main goal was to assess the prevalence of micronutrient deficiencies in patients with decompensated cirrhosis. This was a prospective single-center study including 125 consecutive patients hospitalized for acute decompensation of cirrhosis (mostly of alcoholic etiology). A blood test including trace elements and vitamins was performed on admission. The main micronutrient deficiencies observed were vitamin D (in 94.5%), vitamin A (93.5%), vitamin B6 (60.8%) and zinc (85.6%). Patients in Child-Pugh class C had lower levels of vitamin A (p < 0.0001), vitamin E (p = 0.01) and zinc (p < 0.001), and higher levels of ferritin (p = 0.002) and vitamin B12 (p < 0.001) than those in Child-Pugh class A and B. Patients with a higher model of end-stage liver disease (MELD) score had lower levels of vitamin A (p < 0.0001), vitamin E (p < 0.001), magnesium (p = 0.01) and zinc (p = 0.001), and higher levels of ferritin (p = 0.002) and vitamin B12 (p < 0.0001). Severe hepatic insufficiency correlated with lower levels of zinc, vitamin E and vitamin A, and higher levels of vitamin B12 and ferritin.

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“…We adjusted PF, RBP and PZn values for inflammation using the regression correction approach proposed by the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) group. This approach accounts for the magnitude of inflammation measured by CRP and AGP, and therefore allows for more precise adjustments of acute phase proteins [ 35 , 36 ]. Iron deficiency (ID) was defined as adjusted PF < 15 µg/L [ 24 ].…”

Section: Methodsmentioning

confidence: 99%

“…3 Median (inter-quartile range) (all such values). 4 Plasma ferritin adjusted for inflammation [35]. 5 Adjusted plasma ferritin < 15 µg/L [24].…”

Section: Anemiamentioning

confidence: 99%

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Examining Associations of HIV and Iron Status with Nutritional and Inflammatory Status, Anemia, and Dietary Intake in South African Schoolchildren

et al. 2021

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The etiology of multifactorial morbidities such as undernutrition and anemia in children living with the human immunodeficiency virus (HIV) (HIV+) on antiretroviral therapy (ART) is poorly understood. Our objective was to examine associations of HIV and iron status with nutritional and inflammatory status, anemia, and dietary intake in school-aged South African children. Using a two-way factorial case-control design, we compared four groups of 8 to 13-year-old South African schoolchildren: (1) HIV+ and low iron stores (inflammation-unadjusted serum ferritin ≤40 µg/L), n = 43; (2) HIV+ and iron sufficient non-anemic (inflammation-unadjusted serum ferritin >40 µg/L, hemoglobin ≥115 g/L), n = 41; (3) children without HIV (HIV-ve) and low iron stores, n = 45; and (4) HIV-ve and iron sufficient non-anemic, n = 45. We assessed height, weight, plasma ferritin (PF), soluble transferrin receptor (sTfR), plasma retinol-binding protein, plasma zinc, C-reactive protein (CRP), α-1-acid glycoprotein (AGP), hemoglobin, mean corpuscular volume, and selected nutrient intakes. Both HIV and low iron stores were associated with lower height-for-age Z-scores (HAZ, p < 0.001 and p = 0.02, respectively), while both HIV and sufficient iron stores were associated with significantly higher CRP and AGP concentrations. HIV+ children with low iron stores had significantly lower HAZ, significantly higher sTfR concentrations, and significantly higher prevalence of subclinical inflammation (CRP 0.05 to 4.99 mg/L) (54%) than both HIV-ve groups. HIV was associated with 2.5-fold higher odds of iron deficient erythropoiesis (sTfR >8.3 mg/L) (95% CI: 1.03–5.8, p = 0.04), 2.7-fold higher odds of subclinical inflammation (95% CI: 1.4–5.3, p = 0.004), and 12-fold higher odds of macrocytosis (95% CI: 6–27, p < 0.001). Compared to HIV-ve counterparts, HIV+ children reported significantly lower daily intake of animal protein, muscle protein, heme iron, calcium, riboflavin, and vitamin B12, and significantly higher proportions of HIV+ children did not meet vitamin A and fiber requirements. Compared to iron sufficient non-anemic counterparts, children with low iron stores reported significantly higher daily intake of plant protein, lower daily intake of vitamin A, and lower proportions of inadequate fiber intake. Along with best treatment practices for HIV, optimizing dietary intake in HIV+ children could improve nutritional status and anemia in this vulnerable population. This study was registered at clinicaltrials.gov as NCT03572010.

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Adjusting iron and vitamin A status in settings of inflammation: a sensitivity analysis of the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) approach

Cited by 23 publications

References 30 publications

Influence of Inflammation on Assessing Iron-Deficiency Anemia in Cuban Preschool Children

Influence of Inflammation on Assessing Iron-Deficiency Anemia in Cuban Preschool Children

Micronutrient Deficiencies in Patients with Decompensated Liver Cirrhosis

Examining Associations of HIV and Iron Status with Nutritional and Inflammatory Status, Anemia, and Dietary Intake in South African Schoolchildren

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