Multiple Indicators of Undernutrition, Infection, and Inflammation in Lactating Women Are Associated with Maternal Iron Status and Infant Anthropometry in Panama: The MINDI Cohort

Abstract

Maternal infections, nutrient deficiencies, and inflammation (MINDI) co-exist in lactating indigenous women in Panama, but their impact on maternal iron status and infant growth is unknown. For this secondary analysis of cross-sectional data of lactating mothers from our MINDI cohort, we investigated associations of MINDI variables with maternal anemia, elevated serum transferrin receptor (sTfR), low serum iron, hepcidin, ferritin, and infant weight-for-age (WAZ), length-for-age (LAZ), and head-circumference-for-age (HCAZ) Z-scores in 99 mother-infant dyads. A bootstrapping resampling procedure preselected covariates for inclusion in multivariable regressions models from chronic maternal infections and nutritional status [folate, vitamins A, D, retinol-binding protein (RBP), insulin-growth factor-1 (IGF-1)] and inflammation [C-reactive protein (CRP), cytokines, platelet indices] indicators. Anemia was prevalent (53.5%) but underestimated due to widespread low plasma volume (<2.2 L, 79.9%) and was associated with indicators of malnutrition [lower IGF-1, body mass index (BMI), vitamin D, and intake of green/leafy vegetables], but not inflammation. Higher CRP was associated with lower serum iron, and higher hepcidin and ferritin, whereas maternal platelets were associated with lower HCAZ (β = −0.22), WAZ (β = −0.17), and LAZ (β = −0.17). Higher LAZ was also associated with maternal serum vitamin D (β = 0.23), whereas maternal iron supplementation lowered LAZ (β = −0.22). Assessment of iron status in this MINDI cohort is complex and supplementation strategies must consider consequences for both the mother and the infant.

Multiple Infections, Nutrient Deficiencies, and Inflammation as Determinants of Anemia and Iron Status during Pregnancy: The MINDI Cohort

“…The associations of low weight-for-height category and lower folate and vitamin A with both anemia and lower Hb suggest the presence of anemia of undernutrition, mimicking previously reported results in lactating women from the same cohort, where anemia of undernutrition was also evident [ 101 ]. The term ‘anemia of undernutrition’ is used to capture the range of nutritional deficiencies that contribute to anemia, and it encompasses iron and other macro- and micronutrient deficiencies [ 102 ].…”

Determinants of household-, maternal- and child-related factors associated with nutritional status among children under five in Mali: evidence from a Demographic and Health Survey, 2018

“…Conversely, in the younger age group, taking Fe supplements has been associated with higher odds of experiencing wasting. Similarly, in a study conducted in Panama, supplementing lactating mothers with Fe during the first 6 months of the lactation period was found to be negatively associated with the length-for-age Z score of their children ( 36 ) . This phenomenon is particularly evident in areas with high parasitic infestations, which contribute to childhood undernutrition.…”

The prognostic value of retinol binding protein in geriatric hip fractures after surgeries: A propensity score matching and 1-year follow-up study

“…Moreover, a study comparing the predictive efficiency of various bone parameters reported that RBP, after alkaline phosphatase and age, was the strongest predictor for BMD in treated postmenopausal osteoporosis [ 23 ]. Similarly, many studies also suggested that RBP may relate to vitamin D by influencing nutrition status [ 24 , 25 ]. As for the relation between RBP and fractures, a study that enrolled the patients with osteoporotic fractures and age-matched control subjects showed that the patients with osteoporotic hip fractures have lower RBP than their controls [ 26 ].…”