Asymptomatic malaria infection affects the interpretation of biomarkers of iron and vitamin A status, even after adjusting for systemic inflammation, but does not affect plasma zinc concentrations among young children in Burkina Faso.

Abstract

BACKGROUND:

Biomarkers of iron [plasma ferritin (pF)], vitamin A [retinol binding protein (RBP)], and zinc status [plasma zinc (pZn)] are affected by the acute phase response, independent of micronutrient status.

OBJECTIVE:

The objective of these analyses was to assess how asymptomatic malaria infection affects the interpretation of these biomarkers after adjustment for elevated acute phase proteins (APPs).

METHODS:

Soluble transferrin receptor (sTfR), pF, RBP, and pZn concentrations were measured among 451 asymptomatic children aged 6-23 mo in Burkina Faso and adjusted for elevated APP (C-reactive protein ≥5 mg/L and/or α-1-acid-glycoprotein ≥1 g/L) based on a 4-group categorical model. Plasma histidine-rich protein II (HRP2) concentrations ≥0.75 μg/L were considered indicative of current or recent malaria parasitemia.

RESULTS:

Of the children in the study, 57.4% had at least 1 elevated APP, and 48.5% had elevated HRP2. After adjusting for APP, children with elevated HRP2 had higher pF (23.5 ± 1.5 μg/L vs. 11.1 ± 0.8 μg/L; P < 0.001) and lower RBP (0.79 ± 0.01 μmol/L vs. 0.92 ± 0.01 μmol/L; P < 0.001) than those without, but there were no differences in pZn among those with and without elevated HRP2 (64.9 ± 12.7 μg/dL vs. 64.9 ± 11.1 μg/dL; P = 0.98). Children with elevated HRP2 had higher sTfR than those without (17.6 ± 0.5 mg/L vs. 12.3 ± 0.4 mg/L; P < 0.0001). After adjusting for HRP2, along with APP, the estimated prevalence of iron deficiency (pF < 12 μg/L) increased from 38.7% to 50.6% and vitamin A deficiency (RBP < 0.84 μmol/L) decreased from 33.4% to 27.7%.

CONCLUSIONS:

Asymptomatic malaria is associated with indicators of micronutrient status, even after adjusting for APP. Adjusting indicators of iron and vitamin A status based only on APP may inaccurately estimate the prevalence of micronutrient deficiencies in settings with a high prevalence of malaria and inflammation. This trial was registered at clinicaltrials.gov as NCT00944853.

• Authors: K Ryan Wessells, Sonja Y Hess, Zinewendé P Ouédraogo, Noel Rouamba, Jean-Bosco Ouédraogo, Kenneth H Brown
• Journal: The Journal of nutrition (J Nutr) Vol. 144 Issue 12 Pg. 2050-8 (Dec 2014) ISSN: 1541-6100 [Electronic] United States
• PMID: 25411038 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2014 American Society for Nutrition.

Chemical References

• Acute-Phase Proteins
• Biomarkers
• Hemoglobins
• Iron, Dietary
• Micronutrients
• Orosomucoid
• Proteins
• Retinol-Binding Proteins
• histidine-rich proteins
• Vitamin A
• C-Reactive Protein
• Ferritins
• Zinc

Topics

• Acute-Phase Proteins (metabolism)
• Acute-Phase Reaction (blood)
• Adolescent
• Anemia, Iron-Deficiency (epidemiology)
• Asymptomatic Diseases (epidemiology)
• Biomarkers (blood)
• Burkina Faso
• C-Reactive Protein (metabolism)
• Child
• Cross-Sectional Studies
• Dietary Supplements
• Female
• Ferritins (blood)
• Hemoglobins (metabolism)
• Humans
• Iron, Dietary (administration & dosage)
• Linear Models
• Malaria (blood, diagnosis, epidemiology)
• Male
• Micronutrients (blood)
• Nutritional Status
• Orosomucoid (metabolism)
• Prevalence
• Proteins (metabolism)
• Randomized Controlled Trials as Topic
• Retinol-Binding Proteins (metabolism)
• Vitamin A (administration & dosage, blood)
• Vitamin A Deficiency (epidemiology)
• Zinc (administration & dosage, blood)