Comparative Effectiveness of Zinc Protoporphyrin and Hemoglobin Concentrations in Identifying Iron Deficiency in a Group of Low-Income, Preschool-Aged Children: Practical Implications of Recent Illness

Crowell, Rebecca; Ferris, Ann M.; Wood, Richard J.; Joyce, Patricia A.; Slivka, Hilda

doi:10.1542/peds.2006-0156

Cited by 25 publications

(19 citation statements)

References 43 publications

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“…In children aged 9-30 months from an intercity clinic, prevalence of anemia was 35%, ID was 7% and IDA was 8% (Bogen et al, 2000). In a group of low-income preschool children, prevalence of anemia was 18.8%, ID was 11.7% and IDA was 5% (Crowell et al, 2006). Even in these studies that have demonstrated that anemia, ID and IDA are increasing in some at risk populations within the United States, the prevalences reported are still lower than those found in the American Samoan children assessed.…”

Section: Discussionmentioning

confidence: 96%

Iron deficiency and anemia: disparity exists between children in American Samoa and children living within the US

2007

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Background/Objectives: Healthy People 2010 emphasizes elimination of health disparity and improvements in anemia and iron deficiency (ID). The study purpose was to (1) determine the prevalence of anemia, ID and ID anemia (IDA) in children living in American Samoa and (2) compare the prevalence to that found in children living in the United States. Subjects/Methods: A total of 211 children from American Samoa, aged 1-5 years of age, participated in this cross-sectional study. Prevalence of anemia, ID and IDA were determined and comparison made using data obtained from children living in the United States. Anemia was diagnosed as hemoglobin (Hb) o110.0 g/l, ID as erythrocyte protoporphyrin (EP) 470 mmol/mol heme and IDA as Hb o110.0 g/l and EP 470 mmol/mol heme. Results: Anemia, ID and IDA prevalence was 33, 70 and 33%, respectively. The results of children from the United States were as follows: anemia, 9%; ID, 10% and IDA, 2%. Within American Samoan children, ID is positively associated with being breastfed o6 months (Po0.05) and anemia and IDA with lower household income (Po0.05; Po0.01). Mean Hb was significantly lower (Po0.001) and mean EP was significantly higher (Po0.001) than those within children living in the United States. Conclusion: To meet Healthy People 2010 goals in children aged 1-2 years, the prevalence of ID in children living in American Samoa would need to decrease from 83 to 5% and in children aged 3-5 years from 59 to 1%. It is critical to ensure that populations within the United States and its territories are provided appropriate resources to promote health and prevent disease.

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Section: Discussionmentioning

confidence: 96%

Iron deficiency and anemia: disparity exists between children in American Samoa and children living within the US

2007

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“…Elevated ZPP levels indicate Pb-induced inhibition of heme biosynthesis [10]. Whereas, PbB level is a measure of recent exposure, the ZPP/heme ratio may be useful as a biomarker for prolonged Pb exposure, since elevated ZPP levels lag elevated PbB levels by weeks to months, and may reflect chronic Pb exposure for up to two years [13–16]. Elevated ZPP, a biomarker of Pb toxicity, may also be an indication of Fe deficiency in children, although this is not invariably the case, since the ZPP measure has been shown to have a high false-positive rate for indication of Fe deficiency [16].…”

Section: Introductionmentioning

confidence: 99%

Declining blood lead and zinc protoporphyrin levels in Ecuadorian Andean children

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Buchanan

et al. 2013

Clinical Biochemistry

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Objectives To investigate current lead (Pb) exposure in children living in Andean Ecuadorian communities. Blood Pb (PbB) and zinc protoporphyrin (ZPP) levels were used respectively as biomarkers of acute and chronic Pb poisoning. The current PbB-ZPP levels were compared with previous pediatric PbB-ZPP levels recorded over years in the study area. Design and Methods Samples of whole blood were collected from 22 Andean children of Quechua and Mestizo backgrounds and measured for PbB concentrations by graphite furnace atomic absorption spectroscopy. ZPP/heme ratio and ZPP whole blood (ZPP WB) levels were measured with a hematofluorometer. Results The mean PbB level for children in the current study group was 14.5 μg/dL, which was significantly lower than the mean PbB level of 41.1 μg/dL found in the same study area in the 1996–2000 test period, and lower than the 22.2 μg/dL mean level found in the 2003–2007 period. The current mean ZPP/heme ratio was 102.1 μmol/mol, and the mean ZPP WB level was 46.3 μg/dL, both lower than values previously found in children in the study area. Conclusion While the current pediatric PbB-ZPP levels in the study area remain elevated in some children, the overall levels indicate a decline relative to levels observed in the same Pb-contaminated area in the period between 1996 and 2007. The elevated ZPP levels suggest a history of chronic Pb exposure, and potential iron deficiency in some children. The overall reduction in PbB-ZPP levels suggests a positive outcome of a Pb-exposure education and prevention program, and the therapeutic intervention of succimer chelation therapy.

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“…Due to their higher prevalence of recent acute infection, the results in children three to five years of age were most likely to have been affected by such misclassification. For example, in a study of red blood cell protoporphyrin and serum ferritin in U.S. preschool children, more than half the children had evidence of a recent illness, but CRP was elevated in only 12.4% [34]. …”

Section: Discussionmentioning

confidence: 99%

Is Erythrocyte Protoporphyrin a Better Single Screening Test for Iron Deficiency Compared to Hemoglobin or Mean Cell Volume in Children and Women?

et al. 2017

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Hemoglobin (Hb), mean cell volume (MCV), and erythrocyte protoporphyrin (EP) are commonly used to screen for iron deficiency (ID), but systematic evaluation of the sensitivity and specificity of these tests is limited. The objective of this study is to determine the sensitivity and specificity of Hb, MCV, and EP measurements in screening for ID in preschool children, non-pregnant women 15–49 years of age, and pregnant women. Data from the National Health and Nutrition Examination Surveys (NHANES) (NHANES 2003–2006: n = 861, children three to five years of age; n = 3112, non-pregnant women 15 to 49 years of age. NHANES 1999–2006: n = 1150, pregnant women) were examined for this purpose. Children or women with blood lead ≥10 µg/dL or C-reactive protein (CRP) >5.0 mg/L were excluded. ID was defined as total body iron stores <0 mg/kg body weight, calculated from the ratio of soluble transferrin receptor (sTfR) to serum ferritin (SF). The receiver operating characteristic (ROC) curve was used to characterize the sensitivity and specificity of Hb, MCV, and EP measurements in screening for ID. In detecting ID in children three to five years of age, EP (Area under the Curve (AUC) 0.80) was superior to Hb (AUC 0.62) (p < 0.01) but not statistically different from MCV (AUC 0.73). In women, EP and Hb were comparable (non-pregnant AUC 0.86 and 0.84, respectively; pregnant 0.77 and 0.74, respectively), and both were better than MCV (non-pregnant AUC 0.80; pregnant 0.70) (p < 0.01). We concluded that the sensitivity and specificity of EP in screening for ID were consistently superior to or at least as effective as those of Hb and MCV in each population examined. For children three to five years of age, EP screening for ID was significantly better than Hb and similar to MCV. For both non-pregnant and pregnant women, the performance of EP and Hb were comparable; both were significantly superior to MCV.

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Comparative Effectiveness of Zinc Protoporphyrin and Hemoglobin Concentrations in Identifying Iron Deficiency in a Group of Low-Income, Preschool-Aged Children: Practical Implications of Recent Illness

Cited by 25 publications

References 43 publications

Iron deficiency and anemia: disparity exists between children in American Samoa and children living within the US

Iron deficiency and anemia: disparity exists between children in American Samoa and children living within the US

Declining blood lead and zinc protoporphyrin levels in Ecuadorian Andean children

Is Erythrocyte Protoporphyrin a Better Single Screening Test for Iron Deficiency Compared to Hemoglobin or Mean Cell Volume in Children and Women?

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