Overview of the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) Project

Abstract

Anemia remains a widespread public health problem. Although iron deficiency is considered the leading cause of anemia globally, the cause of anemia varies considerably by country. To achieve global targets to reduce anemia, reliable estimates of the contribution of nutritional and non-nutritional causes of anemia are needed to guide interventions. Inflammation is known to affect many biomarkers used to assess micronutrient status and can thus lead to incorrect diagnosis of individuals and to overestimation or underestimation of the prevalence of deficiency in a population. Reliable assessment of iron status is particularly needed in settings with high infectious disease burden, given the call to screen for iron deficiency to mitigate potential adverse effects of iron supplementation. To address these information gaps, in 2012 the CDC, National Institute for Child Health and Human Development, and Global Alliance for Improved Nutrition formed a collaborative research group called Biomarkers Reflecting Inflammation and Nutrition Determinants of Anemia (BRINDA). Data from nationally and regionally representative nutrition surveys conducted in the past 10 y that included preschool children and/or women of childbearing age were pooled. Of 25 data sets considered for inclusion, 17 were included, representing ∼30,000 preschool children, 26,000 women of reproductive age, and 21,000 school-aged children from all 6 WHO geographic regions. This article provides an overview of the BRINDA project and describes key research questions and programmatic and research implications. Findings from this project will inform global guidelines on the assessment of anemia and micronutrient status and will guide the development of a research agenda for future longitudinal studies.

Keywords: Anemia; biomarkers; inflammation; iron; public health.

FIGURE 1

Organizational chart for the BRINDA project. BRINDA, Biomarkers Reflecting Inflammation and Nutrition Determinants of Anemia; NICHD, Eunice Kennedy Shriver National Institute of Child Health and Human Development.

FIGURE 2

Selection of the BRINDA project data sets. AGP, α-1-acid glycoprotein; CRP, C-reactive protein; Hb, hemoglobin. BRINDA, Biomarkers Reflecting Inflammation and Nutrition Determinants of Anemia.

FIGURE 3

BRINDA country data sets. Total sample size of ∼30,000 preschool children, 21,000 school-aged children, and 26,000 women of reproductive age from 17 data sets from 15 countries. BRINDA, Biomarkers Reflecting Inflammation and Nutrition Determinants of Anemia.

FIGURE 4

Hypothetical example of serum ferritin concentrations in populations with and without inflammation. A hypothetical population experiencing inflammation will exhibit increased ferritin concentrations shown by the rightward shift of the distribution of log(ferritin). In such a scenario the area shaded with solid lines represents the portion of the population misclassified as having sufficient iron stores while experiencing inflammation. These individuals would be correctly identified as having insufficient iron stores (and fall in the dashed line shaded area) if ferritin samples were taken when the population was not experiencing inflammation.