The Association Between Acute Phase Proteins and Transferrin Receptor Levels in Non-Pregnant Women in Papua New Guinea Open Access

Abstract

Background: Iron deficiency is an important global public health issue. Creating a strategy to address this problem can be difficult due to extraneous variables in populations that affect the condition. Inflammation is important to consider when diagnosing iron deficiency because the presence of inflammation inflates iron deficiency measurements. Acute phase proteins known as alpha-1-acid glycoprotein (AGP) and C-reactive protein (CRP) are biomarkers of inflammation. Indicators used to diagnosis this condition are hemoglobin concentration, zinc protoporphyrin, mean cell volume, transferrin receptor (TfR) concentration, and serum ferritin concentration.

Objective: The purpose of this study was to determine if TfR is affected by inflammation in Papua New Guinea and if a relationship exists between elevated TfR and elevated CRP, and elevated TfR and elevated AGP. The study focused on non-pregnant women aged 15 to 49 who participated in the National Micronutrient Survey of 2005.

Methods: A complex cross sectional study design, which took into account stratification, clustering, and sample weights, was utilized for this study. A two-stage, 100-cluster, proportional to population size (PPS) survey was conducted. Data on 746 women were used during the analysis. Survey logistic modeling techniques were implemented to assess the relationships between TfR, CRP, and AGP.

Results: The unadjusted POR for CRP and TfR was 1.42 (0.74,2.71). This ratio was not significant. The unadjusted POR between AGP and TfR was 1.99 (1.28, 3.10). This ratio was significant. After adjusting the model for relevant covariates and interaction terms, the POR for CRP and TfR, in the rural setting, was 2.54 with a p-value of 0.0112. The POR for AGP and TfR, in the rural setting, the POR was 2.90 with a p-value less than 0.0001.

Conclusions: The results of this study support the alternative hypothesis that there is an association between elevated CRP and elevated TfR and elevated AGP and elevated TfR. Life in a rural or urban setting is a effect modifying factor when using CRP and TFR to look at the relationship between inflammation and iron deficiency. These findings differ from the established notion that TfR levels are not affected by inflammation. In this population, women living in rural settings who have inflammation have a higher prevalence of iron deficiency.

Table of Contents

SECTION PAGE NUMBER

1. INTRODUCTION 1

2. METHODS 11

3. RESULTS 18

4. DISCUSSION 22

5. REFERENCES 27

6. TABLES 30

7. APPENDIX I 41

8. APPENDIX II 57

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Statistics Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	women inflammation papua new guinea alpha 1 acid glycoprotein tfr iron deficiency acute phase proteins transferrin receptor crp c-reative protein agp
Committee Chair / Thesis Advisor	Sullivan, Kevin M, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs CDC

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