The relationship between inherited blood disorders and measures of iron status among young children in Kenya 公开
Derby, Kiersten Smith (2013)
Published
Abstract
Abstract:
Background: Inherited blood disorders may influence iron indicators, which would have implications in areas with high burden of disease.
Objective: To determine if there is an association between inherited blood disorders and iron biomarkers.
Design: We conducted a population-based, cross-sectional survey of 854 children aged 6-35 months in western Kenya. Participants were tested for sickle cell, α-thalassemia, and G6PD deficiency. Ferritin, transferrin receptor (TfR), and zinc protoporphyrin (ZP) were measured, and TfR/ferritin index was calculated. Linear regression, adjusting for sociodemographic characteristics, malaria, and inflammation, was used to assess the association between blood disorders and iron biomarkers.
Results: Inherited blood disorders were common; 18.7% had sickle cell disease or trait, 48.0% had abnormal α-thalassemia genotype, and 6.8% had G6PD deficiency. The percentage of the population with abnormal iron biomarkers varied by indicator, ranging from 19.2% according to ferritin < 12 ug/L to 97.8% using ZP > 80 μmol/mol. Mean unadjusted TfR was highest among children with HbSS genotype compared to HbAS and HbAA (ANOVA p<0.0001). Mean unadjusted ZP was higher among boys with normal genotype compared to those with G6PD deficiency (p=0.02). In multivariate analysis, G6PD deficiency was an independent predictor of ZP among boys (β-coefficient = -0.17, p=0.04). There was interaction between sickle cell and malaria (p=0.01); malaria was a predictor of ZP among children without sickle cell, but not a predictor of ZP among those with sickle cell.
Conclusions: In areas with high prevalence of inherited blood disorders, genotypic differences may independently affect iron biomarkers, particularly TfR and ZP.
Table of Contents
Table of Contents:
Thesis documents
Thesis body and references...10-23
Thesis figures and tables...24-30
Appendices
Appendix 1: Questionnaire...31-54
Appendix 2: Expanded literature review of key
manuscripts...55-59
Appendix 3: Distribution plots of iron indicators: Pre- and
post-log transformation...60-62
Appendix 4: Tables assessing confounding and
interaction...63-68
a) ZP and Sickle Cell Trait/Disease
b) TfR and Sickle Cell Trait/Disease
c) SF and Sickle Cell Trait/Disease
d) Index and Sickle Cell Trait/Disease
e) TfR and alpha-thalassemia
f) ZP and G6PD deficiency among boys
Appendix 5: Multiple linear regression models...69-83
a) ZP and Sickle Cell Trait/Disease
i. Exhaustive
ii. Reduced
iii. Final
b) TfR and Sickle Cell Trait/Disease
i. Exhaustive
ii. Reduced
iii. Final
c) SF and Sickle Cell Trait/Disease
i. Exhaustive
ii. Reduced
iii. Final
d) Index and Sickle Cell Trait/Disease
i. Exhaustive
ii. Reduced
iii. Final
e) TfR and alpha-thalassemia
i. Exhaustive
ii. Reduced
iii. Final
f) ZP and G6PD deficiency among boys
i. Exhaustive
ii. Reduced
iii. Final
Appendix 6: Interaction terms...84-85
a) Mean ZP by sickle cell and malaria
parasitemia status
b) Mean SF by sickle cell and SES
c) Mean TfR/SF Index by sickle cell and underweight status
Appendix 7: SAS code...86-177
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