Influence of inflammation as measured by α-1-acid glycoprotein on iron status indicators among HIV-positive postpartum Zimbabwean women

Raj, Rahul; Stoltzfus, Rebecca J.; Ntozini, Robert; Mutasa, Kuda; Iliff, Peter; Humphrey, Jean H.

doi:10.1038/ejcn.2008.33

Cited by 15 publications

(14 citation statements)

References 27 publications

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“…Given that the combined TSAT-TIBC-ferritin index classifies patients with inflammatory iron status apart from the other categories, a low ferritin cut-off value seems more justified for the definition of absolute ID in the combined index. Like others [5], [14], we found absolute ID to be much more common in women. As expected, this profile was associated with the lowest mean value for hepcidin.…”

Section: Discussionsupporting

confidence: 85%

A 3-Marker Index Improves the Identification of Iron Disorders in CKD Anaemia

Mercadal¹,

Metzger²,

Haymann³

et al. 2014

PLoS ONE

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BackgroundIron disorders are common and complex in chronic kidney disease (CKD). We sought to determine whether a 3-marker index would improve the classification of iron disorders in CKD anaemia.MethodsWe studied the association between Hb level and iron indexes combining 2 or 3 of the following markers: serum ferritin (<40 ng/mL), transferrin saturation (TSAT<20%) and total iron binding capacity (TIBC<50 µmol/L) in 1011 outpatients with non-dialysis CKD participating in the Nephrotest study. All had glomerular filtration rates measured (mGFR) by 51Cr-EDTA renal clearance; 199 also had hepcidin measures.ResultsThe TSAT-TIBC-ferritin index explained Hb variation better than indexes combining TSAT-TIBC or ferritin-TSAT. It showed hypotransferrinaemia and non-inflammatory functional iron deficiency (ID) to be more common than either absolute or inflammatory ID: 20%, 19%, 6%, and 2%, respectively. Hb was lower in all abnormal, compared with normal, iron profiles, and decreased more when mGFR was below 30 mL/min/1.73 m2 (interaction p<0.0001). In patients with mGFR<30 mL/min/1.73 m2, the Hb decreases associated with hypotransferrinaemia, non-inflammatory functional ID, and absolute ID were 0.83±0.16 g/dL, 0.51±0.18 and 0.89±0.29, respectively. Compared with normal iron profiles, hepcidin was severely depressed in absolute ID but higher in hypotransferrinaemia.ConclusionsThe combined TSAT-TIBC-ferritin index identifies hypotransferrinaemia and non-inflammatory functional ID as the major mechanisms of iron disorders in CKD anaemia. Both disorders were associated with a greater decrease in Hb when mGFR was <30 mL/min/1.73 m2. Taking these iron profiles into account may be useful in stratifying patients in clinical trials of CKD anaemia and might improve the management of iron therapy.

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Section: Discussionsupporting

confidence: 85%

A 3-Marker Index Improves the Identification of Iron Disorders in CKD Anaemia

Mercadal¹,

Metzger²,

Haymann³

et al. 2014

PLoS ONE

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“…Although the results of the present analysis correspond with findings reported in some studies (12,13) , other studies did not find associations between inflammation and anaemia (14,15) . Whether or not an association between inflammation and anaemia is found in a population may be dependent on a variety of things, such as the presence of factors that may be causes of anaemia and/or inflammation.…”

Section: Discussionsupporting

confidence: 85%

Relationship between markers of inflammation and anaemia in children of Papua New Guinea

Shinoda

Sullivan

Tripp

et al. 2012

Public Health Nutr.

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Objective: To assess the association of the acute-phase protein biomarkers, C-reactive protein (CRP) and a 1 -acid glycoprotein (AGP), with anaemia in children aged 6-59?9 months in Papua New Guinea. Design: A nationally representative household-based cross-sectional survey of children aged 6-59?9 months was used to assess the relationships between various combinations of elevated CRP (.5 mg/l) and AGP (.1?2 g/l) with anaemia. Logistic regression was used to determine if other factors, such as age, sex, measures of anthropometry, region, urban/rural residence and household size, modified or confounded the acute-phase protein-anaemia association. Setting: Papua New Guinea. Subjects: A total of 870 children aged 6-59?9 months from the 2005 Papua New Guinea National Micronutrient Survey were assessed. Results: The following prevalence estimates were found: anaemia 48 %; elevated CRP 32 %; and elevated AGP 33 %. Children with elevated CRP had a prevalence of anaemia of 66 % compared with children with normal CRP who had a prevalence of 40 %. Corresponding estimates for AGP were 61 % and 42 %, respectively. Similar results were found with combinations of elevated CRP and AGP. The higher prevalence of anaemia in children with elevated CRP and/or AGP was still present after controlling for confounders. Conclusions: Elevated levels of CRP and AGP were significantly associated with a higher prevalence of anaemia in the children surveyed. There are no expert group recommendations on whether to or how to account for markers of inflammation in presenting results on anaemia prevalence. Additional research would be helpful to clarify this issue.

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“…The impacts of infection on soluble transferrin receptors and hemoglobin remain unclear. Although iron status appears to be the main factor affecting soluble transferrin receptor concentration, it was reported to be decreased in surgical patients and in individuals with malarial and HIV infection (154,(165)(166)(167). Hemoglobin was suppressed in British, Zambian, and Zanzibari children during the APR and found to be inversely related to serum ferritin concentration, supporting its role as a reactive iron (23,131,168).…”

Section: Apps As Markers Of Infection For Nutrition Interventionsmentioning

confidence: 80%

Undernutrition, the Acute Phase Response to Infection, and Its Effects on Micronutrient Status Indicators

Bresnahan

Tanumihardjo

2014

Advances in Nutrition

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Infection and undernutrition are prevalent in developing countries and demonstrate a synergistic relation. Undernutrition increases infectionrelated morbidity and mortality. The acute phase response (APR) is an innate, systemic inflammatory reaction to a wide array of disruptions in a host's homeostasis, including infection. Released from immune cells in response to deleterious stimuli, proinflammatory cytokines act on distant tissues to induce behavioral (e.g., anorexia, weakness, and fatigue) and systemic effects of the APR. Cytokines act to increase energy and protein requirements to manifest fever and support hepatic acute phase protein (APP) production. Blood concentrations of glucose and lipid are augmented to provide energy to immune cells in response to cytokines. Additionally, infection decreases intestinal absorption of nutrients and can cause direct loss of micronutrients. Traditional indicators of iron, zinc, and vitamin A status are altered during the APR, leading to inaccurate estimations of deficiency in populations with a high or unknown prevalence of infection. Blood concentrations of APPs can be measured in nutrition interventions to assess the time stage and severity of infection and correct for the APR; however, standardized cutoffs for nutrition applications are needed. Protein-energy malnutrition leads to increased gut permeability to pathogens, abnormal immune cell populations, and impaired APP response. Micronutrient deficiencies cause specific immune impairments that affect both innate and adaptive responses. This review describes the antagonistic interaction between the APR and nutritional status and emphasizes the need for integrated interventions to address undernutrition and to reduce disease burden in developing countries. Adv Nutr 2014;5:702-711.

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Influence of inflammation as measured by α-1-acid glycoprotein on iron status indicators among HIV-positive postpartum Zimbabwean women

Cited by 15 publications

References 27 publications

A 3-Marker Index Improves the Identification of Iron Disorders in CKD Anaemia

A 3-Marker Index Improves the Identification of Iron Disorders in CKD Anaemia

Relationship between markers of inflammation and anaemia in children of Papua New Guinea

Undernutrition, the Acute Phase Response to Infection, and Its Effects on Micronutrient Status Indicators

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