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Journal ArticleDOI

Adjusting ferritin concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project

TL;DR: This study contributes to the evidence base to guide decisions about how and when to adjust ferritin for inflammation and lends support for the use of internal regression correction to estimate the prevalence of depleted iron stores in regions with inflammation.
About: This article is published in The American Journal of Clinical Nutrition.The article was published on 2017-07-01 and is currently open access. It has received 232 citations till now. The article focuses on the topics: Ferritin & Anemia.
Citations
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Journal ArticleDOI
TL;DR: This review provides recent updates and guidance on the diagnosis and management of iron deficiency anaemia in multiple clinical settings.
Abstract: Iron deficiency anaemia is a global health concern affecting children, women and the elderly, whilst also being a common comorbidity in multiple medical conditions. The aetiology is variable and attributed to several risk factors decreasing iron intake and absorption or increasing demand and loss, with multiple aetiologies often coexisting in an individual patient. Although presenting symptoms may be nonspecific, there is emerging evidence on the detrimental effects of iron deficiency anaemia on clinical outcomes across several medical conditions. Increased awareness about the consequences and prevalence of iron deficiency anaemia can aid early detection and management. Diagnosis can be easily made by measurement of haemoglobin and serum ferritin levels, whilst in chronic inflammatory conditions, diagnosis may be more challenging and necessitates consideration of higher serum ferritin thresholds and evaluation of transferrin saturation. Oral and intravenous formulations of iron supplementation are available, and several patient and disease-related factors need to be considered before management decisions are made. This review provides recent updates and guidance on the diagnosis and management of iron deficiency anaemia in multiple clinical settings.

202 citations

Journal ArticleDOI
18 Mar 2018
TL;DR: Routine surveillance of serum ferritin and TSAT in at-risk groups is advisable so that iron deficiency can be detected and managed and transferrin saturation, a marker of iron availability, should also be assessed.
Abstract: Patients with inflammatory conditions such as inflammatory bowel disease (IBD), chronic heart failure (CHF), and chronic kidney disease (CKD) have high rates of iron deficiency with adverse clinical consequences. Under normal circumstances, serum ferritin levels are a sensitive marker for iron status but ferritin is an acute-phase reactant that becomes elevated in response to inflammation, complicating the diagnosis. Proinflammatory cytokines also trigger an increase in hepcidin, which restricts uptake of dietary iron and promotes sequestration of iron by ferritin within storage sites. Patients with inflammatory conditions may thus have restricted availability of iron for erythropoiesis and other cell functions due to increased hepcidin expression, despite normal or high levels of serum ferritin. The standard threshold for iron deficiency (<30 μg/L) therefore does not apply and transferrin saturation (TSAT), a marker of iron availability, should also be assessed. A serum ferritin threshold of <100 μg/L or TSAT < 20% can be considered diagnostic for iron deficiency in CHF, CKD, and IBD. If serum ferritin is 100–300 μg/L, TSAT < 20% is required to confirm iron deficiency. Routine surveillance of serum ferritin and TSAT in these at-risk groups is advisable so that iron deficiency can be detected and managed.

139 citations


Cites background or methods from "Adjusting ferritin concentrations f..."

  • ...The authors proposed that corrections should be applied for CRP or AGP levels during iron deficiency surveillance programs [78]....

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  • ...Recently, the effect of adjusting ferritin-based diagnostic criteria for iron deficiency according to levels of CRP or AGP was examined using data from the international Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project [78]....

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  • ...Similar inverse associationswere seen forAGP levels and in preschool children [78]....

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Journal ArticleDOI
TL;DR: The BRINDA project refines approaches to interpret iron and vitamin A biomarker values in settings of inflammation and malaria infection and suggests the use of a new regression approach as well as proposes an anemia framework to which real-world data can be applied.

131 citations

Journal ArticleDOI
TL;DR: More research is needed to determine the validity of inflammation-corrected estimates, their dependence on the etiology of inflammation, and their applicability to individual iron-status assessment in clinical settings.

110 citations


Cites background from "Adjusting ferritin concentrations f..."

  • ...The total sample size for the SF analysis was 27,865 PSC and 24,844 WRA (26); the sample size for sTfR was 11,913 PSC and 11,173 WRA (27); and the sample size for TBI was 8413 PSC and 4258 WRA (25)....

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Journal ArticleDOI
TL;DR: This review examines the emerging as well as the current understanding of iron needs and homeostasis during pregnancy and infancy, uncertainties in ascertaining iron status in these populations, and issues surrounding U-shaped risk curves in iron-replete pregnant women and infants.
Abstract: Iron is particularly important in pregnancy and infancy to meet the high demands for hematopoiesis, growth and development. Much attention has been given to conditions of iron deficiency (ID) and iron deficient anemia (IDA) because of the high global prevalence estimated in these vulnerable life stages. Emerging and preliminary evidence demonstrates, however, a U-shaped risk at both low and high iron status for birth and infant adverse health outcomes including growth, preterm birth, gestational diabetes, gastrointestinal health, and neurodegenerative diseases during aging. Such evidence raises questions about the effects of high iron intakes through supplementation or food fortification during pregnancy and infancy in iron-replete individuals. This review examines the emerging as well as the current understanding of iron needs and homeostasis during pregnancy and infancy, uncertainties in ascertaining iron status in these populations, and issues surrounding U-shaped risk curves in iron-replete pregnant women and infants. Implications for research and policy are discussed relative to screening and supplementation in these vulnerable populations, especially in developed countries in which the majority of these populations are likely iron-replete.

98 citations

References
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Journal ArticleDOI
TL;DR: This paper examines eight published reviews each reporting results from several related trials in order to evaluate the efficacy of a certain treatment for a specified medical condition and suggests a simple noniterative procedure for characterizing the distribution of treatment effects in a series of studies.

33,234 citations


"Adjusting ferritin concentrations f..." refers methods in this paper

  • ...The heterogeneity of estimates across the surveys was assessed with the use of Cochran’s heterogeneity test (26, 27)....

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Book
13 Jun 1985
TL;DR: 1. Oxygen is a toxic gas - an introduction to oxygen toxicity and reactive species, and the chemistry of free radicals and related 'reactive species'
Abstract: 1. Oxygen is a toxic gas - an introductionto oxygen toxicity and reactive species 2. The chemistry of free radicals and related 'reactive species' 3. Antioxidant defences Endogenous and Diet Derived 4. Cellular responses to oxidative stress: adaptation, damage, repair, senescence and death 5. Measurement of reactive species 6. Reactive species can pose special problems needing special solutions. Some examples. 7. Reactive species can be useful some more examples 8. Reactive species can be poisonous: their role in toxicology 9. Reactive species and disease: fact, fiction or filibuster? 10. Ageing, nutrition, disease, and therapy: A role for antioxidants?

21,528 citations

Journal ArticleDOI
TL;DR: The metafor package provides functions for conducting meta-analyses in R and includes functions for fitting the meta-analytic fixed- and random-effects models and allows for the inclusion of moderators variables (study-level covariates) in these models.
Abstract: The metafor package provides functions for conducting meta-analyses in R. The package includes functions for fitting the meta-analytic fixed- and random-effects models and allows for the inclusion of moderators variables (study-level covariates) in these models. Meta-regression analyses with continuous and categorical moderators can be conducted in this way. Functions for the Mantel-Haenszel and Peto's one-step method for meta-analyses of 2 x 2 table data are also available. Finally, the package provides various plot functions (for example, for forest, funnel, and radial plots) and functions for assessing the model fit, for obtaining case diagnostics, and for tests of publication bias.

11,237 citations


"Adjusting ferritin concentrations f..." refers methods in this paper

  • ...The heterogeneity of estimates across the surveys was assessed with the use of Cochran’s heterogeneity test (26, 27)....

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Journal ArticleDOI
TL;DR: A large number of changes, distant from the site or sites of inflammation and involving many organ systems, may accompany inflammation, and the mechanisms mediating them are becoming better understood.
Abstract: A large number of changes, distant from the site or sites of inflammation and involving many organ systems, may accompany inflammation. In 1930 interest was focused on these changes by the discovery of C-reactive protein (so named because it reacted with the pneumococcal C-polysaccharide) in the plasma of patients during the acute phase of pneumococcal pneumonia.1 Accordingly, these systemic changes have since been referred to as the acute-phase response,2 even though they accompany both acute and chronic inflammatory disorders. New acute-phase phenomena continue to be recognized, and the mechanisms mediating them are becoming better understood. This review summarizes much of . . .

6,157 citations


"Adjusting ferritin concentrations f..." refers background in this paper

  • ...In an inflammatory state, ferritin synthesis appears to be upregulated by cytokines independent of iron homeostasis (9, 10)....

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Journal ArticleDOI
TL;DR: Anaemia affects one-quarter of the world’s population and is concentrated in preschool-aged children and women, making it a global public health problem, which makes it difficult to effectively address the problem.
Abstract: Objective To provide current global and regional estimates of anaemia prevalence and number of persons affected in the total population and by population subgroup. Setting and design We used anaemia prevalence data from the WHO Vitamin and Mineral Nutrition Information System for 1993-2005 to generate anaemia prevalence estimates for countries with data representative at the national level or at the first administrative level that is below the national level. For countries without eligible data, we employed regression-based estimates, which used the UN Human Development Index (HDI) and other health indicators. We combined country estimates, weighted by their population, to estimate anaemia prevalence at the global level, by UN Regions and by category of human development. Results Survey data covered 48.8 % of the global population, 76.1 % of preschool-aged children, 69.0 % of pregnant women and 73.5 % of non-pregnant women. The estimated global anaemia prevalence is 24.8 % (95 % CI 22.9, 26.7 %), affecting 1.62 billion people (95 % CI 1.50, 1.74 billion). Estimated anaemia prevalence is 47.4 % (95 % CI 45.7, 49.1 %) in preschool-aged children, 41.8 % (95 % CI 39.9, 43.8 %) in pregnant women and 30.2 % (95 % CI 28.7, 31.6 %) in non-pregnant women. In numbers, 293 million (95 % CI 282, 303 million) preschool-aged children, 56 million (95 % CI 54, 59 million) pregnant women and 468 million (95 % CI 446, 491 million) non-pregnant women are affected. Conclusion Anaemia affects one-quarter of the world's population and is concentrated in preschool-aged children and women, making it a global public health problem. Data on relative contributions of causal factors are lacking, however, which makes it difficult to effectively address the problem.

2,134 citations


"Adjusting ferritin concentrations f..." refers background in this paper

  • ...62 billion people worldwide, although these figures are approximations because of limited available estimates of iron deficiency globally (5)....

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