Malaria Exacerbates Inflammation-induced Bias in Ferritin and Soluble Transferrin Receptor Values.
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Date
2015
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Abstract
Objectives: In the context of malaria and inflammation, the utility of ferritin and soluble transferring
receptor (sTfR), as indicators of iron status may be compromised. In this study, we evaluated the
effects of correcting for malaria and inflammation on the prevalence of iron deficiency (ID) as
estimated by a) ferritin and b) sTfR.
Methods: The analyses used baseline data from 1085 children, 4-8 y, who participated in a
carotenoid biofortified maize flour trial in rural Zambia. For each biomarker, we compared the
prevalence of ID with the prevalence corrected for a) CRP and AGP only; and b) CRP, AGP and
concurrent malaria. Inflammation was defined as CRP>5mg/L and/or AGP>1g/L. Malaria was
defined by microscopy. Children were first stratified into groups defined by inflammation and
malaria status. Correction factors were then generated by dividing the group geometric means by
that of the reference group (those free of both malaria and inflammation). Correction factors were
applied to each individual concentration to generated corrected concentrations.
Results: For ferritin, the unadjusted prevalence of ID (WHO age-specific cut-offs) increased from
7.3% to 9.5% (p<0.01) and 10.3 %( p<0.01), respectively, after correcting for CRP/AGP only, and
CRP, AGP and concurrent malaria combined. For sTfR, the unadjusted ID prevalence (cutoff >8.3
mg/l) decreased from 28% to 21% (p<0.01) after correcting CRP/AGP only, and 19% (p<0.01) after
correcting for CRP, AGP and concurrent malaria. Conclusions: Our findings highlight the need to account for both malaria and inflammation when
interpreting ferritin and sTfr concentrations in malaria endemic regions.
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Barffour Maxwell A, Schulze Kerry, Palmer Amanda, Chileshe Justin, Kalungwana Ng'andwe, Wu Lee, Coles Christian, Klemm Rolf, Arguello Margia, Moss William, West Keith P. Malaria Exacerbates Inflammation-induced Bias in Ferritin and Soluble Transferrin Receptor Values. European Journal of Nutrition & Food Safety. 2015 Special issue; 5(5): 1106-1107.