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Assessment of iron status in settings of inflammation: challenges and potential approaches.
Am J Clin Nutr. 2017 Dec; 106(Suppl 6):1626S-1633S.AJ

Abstract

The determination of iron status is challenging when concomitant infection and inflammation are present because of confounding effects of the acute-phase response on the interpretation of most iron indicators. This review summarizes the effects of inflammation on indicators of iron status and assesses the impact of a regression analysis to adjust for inflammation on estimates of iron deficiency (ID) in low- and high-infection-burden settings. We overviewed cross-sectional data from 16 surveys for preschool children (PSC) (n = 29,765) and from 10 surveys for nonpregnant women of reproductive age (WRA) (n = 25,731) from the Biomarkers Reflecting the Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Effects of C-reactive protein (CRP) and α1-acid glycoprotein (AGP) concentrations on estimates of ID according to serum ferritin (SF) (used generically to include plasma ferritin), soluble transferrin receptor (sTfR), and total body iron (TBI) were summarized in relation to infection burden (in the United States compared with other countries) and population group (PSC compared with WRA). Effects of the concentrations of CRP and AGP on SF, sTfR, and TBI were generally linear, especially in PSC. Overall, regression correction changed the estimated prevalence of ID in PSC by a median of +25 percentage points (pps) when SF concentrations were used, by -15 pps when sTfR concentrations were used, and by +14 pps when TBI was used; the estimated prevalence of ID in WRA changed by a median of +8 pps when SF concentrations were used, by -10 pps when sTfR concentrations were used, and by +3 pps when TBI was used. In the United States, inflammation correction was done only for CRP concentrations because AGP concentrations were not measured; regression correction for CRP concentrations increased the estimated prevalence of ID when SF concentrations were used by 3 pps in PSC and by 7 pps in WRA. The correction of iron-status indicators for inflammation with the use of regression correction appears to substantially change estimates of ID prevalence in low- and high-infection-burden countries. More research is needed to determine the validity of inflammation-corrected estimates, their dependence on the etiology of inflammation, and their applicability to individual iron-status assessment in clinical settings.

Authors+Show Affiliations

Department of Pediatrics, Emory University, Atlanta, GA; psuchde@emory.edu. Nutrition Branch, CDC, Atlanta, GA.Department of Pediatrics, Emory University, Atlanta, GA.Nutrition Branch, CDC, Atlanta, GA.Nutrition Branch, CDC, Atlanta, GA.Medical Research Council (MRC) Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom.Department of Nutrition for Health and Development, WHO, Geneva, Switzerland; and.Helen Keller International and Strengthening Partnerships, Results, and Innovations in Nutrition Globally, Arlington, VA.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

29070567

Citation

Suchdev, Parminder S., et al. "Assessment of Iron Status in Settings of Inflammation: Challenges and Potential Approaches." The American Journal of Clinical Nutrition, vol. 106, no. Suppl 6, 2017, 1626S-1633S.
Suchdev PS, Williams AM, Mei Z, et al. Assessment of iron status in settings of inflammation: challenges and potential approaches. Am J Clin Nutr. 2017;106(Suppl 6):1626S-1633S.
Suchdev, P. S., Williams, A. M., Mei, Z., Flores-Ayala, R., Pasricha, S. R., Rogers, L. M., & Namaste, S. M. (2017). Assessment of iron status in settings of inflammation: challenges and potential approaches. The American Journal of Clinical Nutrition, 106(Suppl 6), 1626S-1633S. https://doi.org/10.3945/ajcn.117.155937
Suchdev PS, et al. Assessment of Iron Status in Settings of Inflammation: Challenges and Potential Approaches. Am J Clin Nutr. 2017;106(Suppl 6):1626S-1633S. PubMed PMID: 29070567.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessment of iron status in settings of inflammation: challenges and potential approaches. AU - Suchdev,Parminder S, AU - Williams,Anne M, AU - Mei,Zuguo, AU - Flores-Ayala,Rafael, AU - Pasricha,Sant-Rayn, AU - Rogers,Lisa M, AU - Namaste,Sorrel Ml, Y1 - 2017/10/25/ PY - 2017/10/27/pubmed PY - 2017/12/19/medline PY - 2017/10/27/entrez KW - infection KW - inflammation KW - iron status KW - preschool children KW - serum ferritin KW - soluble transferrin receptor KW - total-body iron stores KW - women of reproductive age SP - 1626S EP - 1633S JF - The American journal of clinical nutrition JO - Am J Clin Nutr VL - 106 IS - Suppl 6 N2 - The determination of iron status is challenging when concomitant infection and inflammation are present because of confounding effects of the acute-phase response on the interpretation of most iron indicators. This review summarizes the effects of inflammation on indicators of iron status and assesses the impact of a regression analysis to adjust for inflammation on estimates of iron deficiency (ID) in low- and high-infection-burden settings. We overviewed cross-sectional data from 16 surveys for preschool children (PSC) (n = 29,765) and from 10 surveys for nonpregnant women of reproductive age (WRA) (n = 25,731) from the Biomarkers Reflecting the Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Effects of C-reactive protein (CRP) and α1-acid glycoprotein (AGP) concentrations on estimates of ID according to serum ferritin (SF) (used generically to include plasma ferritin), soluble transferrin receptor (sTfR), and total body iron (TBI) were summarized in relation to infection burden (in the United States compared with other countries) and population group (PSC compared with WRA). Effects of the concentrations of CRP and AGP on SF, sTfR, and TBI were generally linear, especially in PSC. Overall, regression correction changed the estimated prevalence of ID in PSC by a median of +25 percentage points (pps) when SF concentrations were used, by -15 pps when sTfR concentrations were used, and by +14 pps when TBI was used; the estimated prevalence of ID in WRA changed by a median of +8 pps when SF concentrations were used, by -10 pps when sTfR concentrations were used, and by +3 pps when TBI was used. In the United States, inflammation correction was done only for CRP concentrations because AGP concentrations were not measured; regression correction for CRP concentrations increased the estimated prevalence of ID when SF concentrations were used by 3 pps in PSC and by 7 pps in WRA. The correction of iron-status indicators for inflammation with the use of regression correction appears to substantially change estimates of ID prevalence in low- and high-infection-burden countries. More research is needed to determine the validity of inflammation-corrected estimates, their dependence on the etiology of inflammation, and their applicability to individual iron-status assessment in clinical settings. SN - 1938-3207 UR - https://www.unboundmedicine.com/medline/citation/29070567/Assessment_of_iron_status_in_settings_of_inflammation:_challenges_and_potential_approaches_ L2 - https://academic.oup.com/ajcn/article-lookup/doi/10.3945/ajcn.117.155937 DB - PRIME DP - Unbound Medicine ER -