The Relationship Between Anemia and Biomarkers of Inflammation (CRP and AGP) in Women of Papua New Guinea Open Access

Abstract

The Relationship Between Anemia and Biomarkers of Inflammation
(CRP and AGP) in Women of Papua New Guinea

By Meredith Kanago

Background: Anemia is a major public health problem worldwide, but its burden is
greatest where risk factors such as poor nutrition and low socioeconomic status are
common. Because biomarkers of inflammation have been shown to affect certain
micronutrient measures, including hemoglobin, the primary indicator of anemia status, it
is important to understand this relationship in order to properly assess micronutrient
status in populations.
Objective: This study seeks to evaluate any possible association between anemia status
and the acute-phase protein biomarkers C-reactive protein (CRP) and α-(1) - acid
glycoprotein (AGP) and anemia in non-pregnant women aged 18-49 who participated in
the 2005 Papua New Guinea National Micronutrient Survey.
Methods: The 2005 Papua New Guinea National Micronutrient Survey was a stratified
PPS survey with a 2-stage cluster design carried out from May to October 2005. Logistic
models were used to analyze data on 662 women to assess the relationship between
anemia and elevated CRP and between anemia and elevated AGP.
Results: The overall weighted prevalence of anemia in this population was 34.9%. The
weighted prevalence of elevated CRP was 10.43%, and the prevalence of elevated AGP
was 7.96%. Controlling for region and recent birth, anemia was significantly associated
with elevated CRP, with an odds ratio of 2.74 (95% CI: 1.23, 6.15) among those in rural
areas. There did not appear to be a similar association among those in urban locations. In
addition, after controlling for region and urban/rural location, anemia was significantly
associated with elevated AGP, with an odds ratio of 3.98 (95% CI: 1.54, 10.26).
Conclusions: This study found that there is a clear association between anemia status and
elevated levels of acute phase proteins in women in Papua New Guinea, suggesting that
the presence of infection could have an effect on assessment of anemia in a population. This
finding underscores the importance of collecting information on inflammatory
biomarkers in nutritional surveys. Future studies should further investigate the
geographic factors involved in this association, including the interaction between
elevated CRP and urban/rural location.

Table of Contents

1. INTRODUCTION..........................................................................1

2. BACKGROUND

2.1 Anemia Overview.............................................................. 2 2.2 Acute Phase Response....................................................... 4

2.3 Acute Phase Response and Micronutrient Status..................... 6

2.4 Papua New Guinea............................................................. 7

3. METHODS

3.1 Null Hypothesis................................................................. 8 3.2 Study Design.................................................................... 8 3.3 Data Collection................................................................. 10 3.4 Analysis........................................................................... 12 3.5 Logistic Regression Modeling................................................ 13

4. RESULTS

4.1 Descriptive Statistics......................................................... 15 4.2 Prevalence of Anemia......................................................... 16

4.3 Prevalence of Elevated CRP and Elevated AGP.......................... 17

4.4 Association Between Anemia Status and CRP........................... 18

4.5 Association Between Anemia Status and AGP........................... 19

4.6 Association Between Anemia Status and Infection Category....... 20

5. DISCUSSION

5.1 Association Between Anemia Status and CRP........................... 21

5.2 Association Between Anemia Status and AGP........................... 22

5.3 Strengths......................................................................... 22 5.4 Limitations........................................................................ 22 5.5 Summary......................................................................... 23 REFERENCES...................................................................................25 TABLES.........................................................................................27 APPENDICES

Appendix I: Data Collection Forms

Appendix II: Assessment of Interaction and Confounding for CRP Model

Appendix III: Assessment of Interaction and Confounding for AGP Model

Appendix IV: Infection Category Table

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	Rollins School of Public Health
Department	Epidemiology
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Nutrition Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	women inflammation epidemiology hemoglobin acute phase response public health anemia nutrition Papua New Guinea AGP CRP
Committee Chair / Thesis Advisor	Sullivan, Kevin M, Emory University
Partnering Agencies	CDC

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