TY - JOUR
T1 - Malaria exacerbates inflammation-associated elevation in ferritin and soluble transferrin receptor with only modest effects on iron deficiency and iron deficiency anaemia among rural Zambian children
AU - Barffour, Maxwell A.
AU - Schulze, Kerry J.
AU - Coles, Christian
AU - Chileshe, Justin
AU - Kalungwana, Ng'andwe
AU - Siamusantu, Ward
AU - Arguello, Margia
AU - Moss, William J.
AU - West, Keith P.
AU - Palmer, Amanda C.
N1 - Funding Information:
We thank the participating children, their families and Mkushi District officials for supporting the study’s implementation. We are also grateful to Dr. Mwanza and the Mkushi District Medical Office for providing bed nets and Coartem to support malaria prevention and control activities. We thank Bess Caswell and Lau-ren Tanz for supporting data collection, Brian Dyer, Mitra Maithilee and Lee Wu for their support in data management and Dr. Douglas Norris for providing inputs to this manuscript. This work was funded by HarvestPlus Challenge Grant #8251, with support from the UK Department for International Development. The views expressed do not necessarily reflect those of Har-vestPlus. MAB received partial support from the DSM Scholars Program through the Sight & Life Global Nutrition Research Institute at Johns Hopkins University and from Foreign Affairs, Trade and Development Canada Grant #112305.
Funding Information:
We thank the participating children, their families and Mkushi District officials for supporting the study's implementation. We are also grateful to Dr. Mwanza and the Mkushi District Medical Office for providing bed nets and Coartem to support malaria prevention and control activities. We thank Bess Caswell and Lauren Tanz for supporting data collection, Brian Dyer, Mitra Maithilee and Lee Wu for their support in data management and Dr. Douglas Norris for providing inputs to this manuscript. This work was funded by HarvestPlus Challenge Grant #8251, with support from the UK Department for International Development. The views expressed do not necessarily reflect those of HarvestPlus. MAB received partial support from the DSM Scholars Program through the Sight & Life Global Nutrition Research Institute at Johns Hopkins University and from Foreign Affairs, Trade and Development Canada Grant #112305.
Publisher Copyright:
© 2017 John Wiley & Sons Ltd
PY - 2018/1
Y1 - 2018/1
N2 - Objective: In 4- to 8-year-old Zambian children (n = 744), we evaluated the effects of adjusting for inflammation (α1-acid glycoprotein >1 g/l), with or without additional adjustment for malaria, on prevalence estimates of iron deficiency (ID) and iron deficiency anaemia (IDA) during low malaria (LowM) and high malaria (HighM) transmission seasons. Methods: To estimate adjustment factors, children were classified as: (i) reference (malaria negative without inflammation), (ii) inflammation without malaria (I), (iii) malaria without inflammation (M) and (iv) inflammation with malaria (IM). We estimated the unadjusted ID or IDA prevalence, and then adjusted for inflammation alone (IDI or IDAI) or inflammation and malaria (IDIM or IDAIM). Results: Mean ferritin was 38 (reference), 45 (I), 43 (M) and 54 μg/l (IM) in LowM, increasing to 44, 56, 96 and 167 μg/l, respectively, in HighM. Corresponding mean sTfR was 6.4, 6.9, 7.9 and 8.4 mg/l in LowM, increasing to 8.2, 9.2. 8.7 and 9.7 mg/l in HighM. Ferritin-based ID, IDI and IDIM were 7.8%, 8.7% or 9.1%, respectively, in LowM and 4.6%, 10.0% or 11.7%, respectively, in HighM. Corresponding soluble transferrin receptor (sTfR)-based estimates were 27.0%, 24.1% and 19.1%, respectively, in LowM, increasing to 53.6%, 46.5% and 45.3%, respectively, in HighM. Additional adjustment for malaria resulted in a ~1- to 2-percentage point change in IDA, depending on biomarker and season. Conclusions: In this population, malaria substantially increased ferritin and sTfR concentrations, with modest effects on ID and IDA prevalence estimates.
AB - Objective: In 4- to 8-year-old Zambian children (n = 744), we evaluated the effects of adjusting for inflammation (α1-acid glycoprotein >1 g/l), with or without additional adjustment for malaria, on prevalence estimates of iron deficiency (ID) and iron deficiency anaemia (IDA) during low malaria (LowM) and high malaria (HighM) transmission seasons. Methods: To estimate adjustment factors, children were classified as: (i) reference (malaria negative without inflammation), (ii) inflammation without malaria (I), (iii) malaria without inflammation (M) and (iv) inflammation with malaria (IM). We estimated the unadjusted ID or IDA prevalence, and then adjusted for inflammation alone (IDI or IDAI) or inflammation and malaria (IDIM or IDAIM). Results: Mean ferritin was 38 (reference), 45 (I), 43 (M) and 54 μg/l (IM) in LowM, increasing to 44, 56, 96 and 167 μg/l, respectively, in HighM. Corresponding mean sTfR was 6.4, 6.9, 7.9 and 8.4 mg/l in LowM, increasing to 8.2, 9.2. 8.7 and 9.7 mg/l in HighM. Ferritin-based ID, IDI and IDIM were 7.8%, 8.7% or 9.1%, respectively, in LowM and 4.6%, 10.0% or 11.7%, respectively, in HighM. Corresponding soluble transferrin receptor (sTfR)-based estimates were 27.0%, 24.1% and 19.1%, respectively, in LowM, increasing to 53.6%, 46.5% and 45.3%, respectively, in HighM. Additional adjustment for malaria resulted in a ~1- to 2-percentage point change in IDA, depending on biomarker and season. Conclusions: In this population, malaria substantially increased ferritin and sTfR concentrations, with modest effects on ID and IDA prevalence estimates.
KW - anaemia
KW - ferritin
KW - inflammation
KW - iron deficiency
KW - malaria
KW - soluble transferrin receptor
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U2 - 10.1111/tmi.13004
DO - 10.1111/tmi.13004
M3 - Article
C2 - 29121448
AN - SCOPUS:85040107853
SN - 1360-2276
VL - 23
SP - 53
EP - 62
JO - Tropical Medicine and International Health
JF - Tropical Medicine and International Health
IS - 1
ER -