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Comparison of indicators of iron deficiency in Kenyan children1–6
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Details:
  • Pubmed ID:
    22456661
  • Pubmed Central ID:
    PMC4697948
  • Description:
    Background

    In the absence of a feasible, noninvasive gold standard, iron deficiency (ID) is best measured by the use of multiple indicators. However, the choice of an appropriate single iron biomarker to replace the multiple-criteria model for screening for ID at the population level continues to be debated.

    Objective

    We compared ID defined as ≥2 of 3 abnormal ferritin (<12 μg/L), soluble transferrin receptor (TfR; >8.3 mg/L), or zinc protoporphyrin (ZP; >80 μmol/mol) concentrations (ie, multiple-criteria model) with ID defined by abnormal concentrations of any of the independent candidate iron biomarkers (ferritin alone, TfR alone, or ZP alone) and TfR/ferritin index (ID, >500). Values either were adjusted for inflammation [as measured by C-reactive protein (>5 mg/L) and α1-acid glycoprotein (>1 g/L) before applying cutoffs for ID] or were unadjusted.

    Design

    In this community-based cluster survey, capillary blood was obtained from 680 children (aged 6–35 mo) for measurement of iron status by using ferritin, TfR, and ZP.

    Results

    On the basis of the multiple-criteria model, the mean (±SE) prevalence of ID was 61.9 ± 2.2%, whereas the prevalences based on abnormal ferritin, TfR, or ZP concentrations or an abnormal TfR/ferritin index were 26.9 ± 1.7%, 60.9 ± 2.2%, 82.8 ± 1.6%, and 43.1 ± 2.3%, respectively, for unadjusted values. The prevalences of ID were higher for adjusted values only for low ferritin and an elevated TfR/ferritin index compared with the unadjusted values. The κ statistics for agreement between the multiple-criteria model and the other iron indicators ranged from 0.35 to 0.88; TfR had the best agreement (κ = 0.88) with the multiple-criteria model. Positive predictive values of ID based on the other iron indicators in predicting ID based on the multiple-criteria model were highest for ferritin and TfR. Receiver operating characteristic curve analysis indicated that TfR (AUC = 0.94) was superior to the other indicators in diagnosing ID based on the multiple-criteria model (P < 0.001). The inflammation effect did not appear to alter these observations appreciably.

    Conclusion

    TfR better estimates the prevalence of ID in preschoolers than do ferritin, ZP, and the TfR/ferritin index on the basis of multiple indexes in a high inflammation, resource-poor setting. This trial was registered at clinicaltrials.gov as NCT101088958.

  • Document Type:
  • Collection(s):
  • Funding:
    CC999999/Intramural CDC HHS/United States
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