Assessing the role of inflammation on iron biomarkers in school-age children and adolescents, the BRINDA project Open Access

Nieckula, Emily (Spring 2023)

Permanent URL: https://etd.library.emory.edu/concern/etds/m326m312c?locale=en
Published

Abstract

OBJECTIVES:

Prevalence estimates for iron deficiency may be underestimated due to inflammation. We examined the relationship between iron biomarkers and inflammation and evaluated the use of the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) adjustment method in school-age children (SAC) and adolescents (ADL).

METHODS:

Surveys from 15 different countries [8 SAC datasets (n = 26,334; age 5-15 years); 15 ADL datasets (n = 19,595; age 10-20 years)] from the BRINDA project were examined, accounting for complex survey design. The prevalence of inflammation (α-1-acid-glycoprotein [AGP] >1 g/L; C-reactive protein [CRP] > 5 mg/L) and iron deficiency (ferritin < 15 ug/L; soluble transferrin receptor (sTfR) > 8.3 mg/L) and rank correlations between CRP or AGP and ferritin or sTfR were estimated. Ferritin and sTfR were adjusted using the BRINDA inflammation-adjustment method using AGP only, CRP only, and both AGP and CRP. The prevalence of iron deficiency was compared with unadjusted estimates.

RESULTS:

Inflammation prevalence varied by dataset from 1.4% to 33%. Unadjusted iron deficiency prevalence ranged from 0% to 43.4%. Ferritin was positively corelated with AGP in 7 out of 8 datasets (r = 0.06-0.48) and with CRP in 19 out of 22 datasets (r = 0.05-0.48). sTfR was positively correlated with AGP in 6 of 7 datasets (r = 0.11- 0.24). Associations between sTfR and CRP were mixed with 7 positive and 6 null associations (r = 0.02 -0.24). Ferritin adjustment for AGP only had the greatest increase, 4.5 pp, compared to 3.7 for AGP and CRP and 3.4 for CRP alone. sTfR adjustment for AGP only had the greatest decrease, 6.4 pp, compared to 5.9 for AGP and CRP and 3 pp for CRP alone.

CONCLUSION:

Failure to adjust ferritin for inflammation biomarker of AGP may result in iron deficiency underestimation among SAC and ADL. Based on limited data for sTfR, preliminary results suggest inflammation adjustment with AGP may be merited. However, further research is needed given the critical data gaps among these population groups. 

Table of Contents

CHAPTER 1: INTRODUCTION ... 1

OBJECTIVE AND AIMS ... 2

DEFINITION OF TERMS ... 4

CHAPTER 2: COMPREHENSIVE REVIEW OF LITERATURE ... 6

INTRODUCTION ... 6

IRON BIOMARKERS: SERUM FERRITIN (SF) AND SOLUBLE TRANSFERRIN RECEPTOR (STFR) ... 7

INFLAMMATION AND IRON BIOMARKERS ... 9

THE BRINDA ADJUSTMENT METHOD ...11

SCHOOL-AGE CHILDREN AND ADOLESCENTS ... 13

CONCLUSION AND FUTURE DIRECTIONS ... 16

CHAPTER 3: MANUSCRIPT ... 18

CONTRIBUTION OF STUDENT ... 20

INTRODUCTIONS ... 23

METHODS ... 24

Study Design and Data Source ... 24

Lab Methods ... 25

Statistical Analysis ... 25

RESULTS ... 26

Sensitivity Analysis ... 29

DISCUSSION ... 31

CONCLUSION ... 34

TABLES ... 35

SUPPLEMENTARY MATERIAL ... 41

CHAPTER 4: CONCLUSION AND RECOMMENDATIONS ... 52

STUDY OVERVIEW ... 52

Strengths ... 53

Limitations ... 53

IMPLICATIONS FOR POLICY AND PRACTICE ... 54

FUTURE RECOMMENDATIONS ... 55

CONCLUSION... 56

ADDITIONAL PAGES... 58

ACRONYMS... 59

REFERENCES... 60

About this Master's Thesis

Rights statement
  • Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.
School
Department
Degree
Submission
Language
  • English
Research Field
Keyword
Committee Chair / Thesis Advisor
Committee Members
Last modified

Primary PDF

Thumbnail Title Date Uploaded Actions
Assessing the role of inflammation on iron biomarkers in school-age children and adolescents, the BRINDA project () 2023-04-20 08:59:42 -0400

Supplemental Files

Thumbnail Title Date Uploaded Actions