Iron, zinc, vitamin A and selenium status in a cohort of Indonesian infants after adjusting for inflammation using several different approaches

Br J Nutr. 2017 Nov;118(10):830-839. doi: 10.1017/S0007114517002860.

Abstract

Inflammation confounds the interpretation of several micronutrient biomarkers resulting in estimates that may not reflect the true burden of deficiency. We aimed to assess and compare the micronutrient status of a cohort of Indonesian infants (n 230) at aged 6, 9 and 12 months by ignoring inflammation (unadjusted) and adjusting four micronutrient biomarkers for inflammation with C-reactive protein (CRP) and α-1-glycoprotein (AGP) using the following methods: (1) arithmetic correction factors with the use of a four-stage inflammation model; and (2) regression modelling. Prevalence of infants with any inflammation (CRP>5 mg/l and/or AGP>1 g/l) was about 25% at each age. Compared with unadjusted values, regression adjustment at 6, 9 and 12 months generated the lowest (P50 % across all ages. In conclusion, without inflammation adjustment, Fe deficiency was grossly under-estimated and vitamin A and Zn deficiency over-estimated, highlighting the importance of correcting for the influence of such, before implementing programmes to alleviate micronutrient malnutrition. However, further work is needed to validate the proposed approaches with a particular focus on assessing the influence of varying degrees of inflammation (i.e. recurrent acute infections and low-grade chronic inflammation) on each affected nutrient biomarker.

Keywords: AGP α-1-glycoprotein; APP acute phase proteins; BRINDA Biomarkers Reflecting Inflammation and Nutritional Determinants Anemia; CRP C-reactive protein; GM geometric mean; RBP retinol-binding protein; sTfR soluble transferrin receptor; Biomarkers; Indonesia; Inflammations; Iron; Selenium; Vitamin A; Zinc.

MeSH terms

  • Anemia, Iron-Deficiency / blood
  • Anemia, Iron-Deficiency / epidemiology
  • Biomarkers / blood
  • C-Reactive Protein / metabolism
  • Cohort Studies
  • Cross-Sectional Studies
  • Deficiency Diseases / blood*
  • Deficiency Diseases / epidemiology
  • Female
  • Ferritins / blood
  • Humans
  • Indonesia / epidemiology
  • Infant
  • Inflammation / blood*
  • Inflammation / complications
  • Inflammation / epidemiology
  • Iron / blood*
  • Iron Deficiencies
  • Male
  • Micronutrients / blood
  • Nutritional Status*
  • Orosomucoid / metabolism
  • Prevalence
  • Retinol-Binding Proteins / metabolism
  • Selenium / blood*
  • Selenium / deficiency
  • Vitamin A / blood*
  • Vitamin A Deficiency / blood
  • Vitamin A Deficiency / epidemiology
  • Zinc / blood*
  • Zinc / deficiency

Substances

  • Biomarkers
  • Micronutrients
  • Orosomucoid
  • Retinol-Binding Proteins
  • Vitamin A
  • C-Reactive Protein
  • Ferritins
  • Iron
  • Selenium
  • Zinc