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. 2017 Oct;13(4):e12404.
doi: 10.1111/mcn.12404. Epub 2016 Dec 7.

Early deterioration of iron status among a cohort of Bolivian infants

Rachel M Burke  1 , Paulina A Rebolledo  2   3 , Anna M Fabiszewski de Aceituno  2 , Rita Revollo  4 , Volga Iñiguez  5 , Mitchel Klein  1 , Carolyn Drews-Botsch  1 , Juan S Leon  1   2 , Parminder S Suchdev  2   3   6
Affiliations

Early deterioration of iron status among a cohort of Bolivian infants

Rachel M Burke et al. Matern Child Nutr. 2017 Oct.

Abstract

Iron deficiency (ID) and iron deficiency anemia (IDA) are major contributors to infant and maternal morbidity worldwide. There is limited longitudinal data on iron status in young infants and on methods to adjust iron biomarkers for inflammation. We aimed to quantify the prevalence of inflammation-adjusted ID, anemia, and IDA over the first year in a cohort of Bolivian infants and their mothers. Healthy mother-infant dyads were recruited from two peri-urban hospitals. Infants provided three blood draws (2, 6-8, and 12-18 months; N = 160); mothers provided two blood draws (1 and 6-8 months postpartum [plus third anemia measurement at 12-18 months]; N = 250). Blood was analyzed for hemoglobin, ferritin, soluble transferrin receptor, C-reactive protein (CRP), and alpha(1)-acid glycoprotein (AGP). Iron biomarkers were adjusted for inflammation using CRP and AGP; hemoglobin cutoffs were adjusted for altitude. Inflammation (elevated CRP or AGP) was 17% among toddlers 12-18 months of age. ID (inflammation-adjusted ferritin) increased with age (<1%, 56%, and 79% at each blood draw), as did anemia and IDA (anemia: 70%, 76%, and 81%; IDA: <1%, 46%, and 68%). Maternal ID declined from the first to second assessment (39% vs. 27%). Inflammation-adjusted ID prevalence was up to 15 percentage points higher than unadjusted estimates. The high prevalence of ID, anemia, and IDA in this cohort of Bolivian infants beginning at 6-8 months of age suggests that early interventions may be necessary in vulnerable populations.

Keywords: anemia; global micronutrient malnutrition; infant nutrition; iron deficiency; iron deficiency anemia; micronutrient deficiencies.

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Conflict of interest statement

Burke, Rebolledo, Fabiszewski de Aceituno, Revollo, Iñiguez, Klein, Drews‐Botsch, Leon, Suchdev: no conflicts of interest. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Figures

Figure 1
Figure 1
Participant Flow. Of 2331 screened mother–infant pairs, 1336 were eligible and 451 singletons enrolled. A total of 365 singleton infants provided samples at 2 months, 310 at 2 and 6–8 months, and 160 at all three time points. 1Maternal first blood draw at 1 month postpartum. Infant first blood draw at 2 months of age. 2Main reasons for loss‐to‐follow‐up and exclusion include failure to complete vaccines on schedule, missing required visits, and lost contact/participant moved out of study area. 3Between first and second infant blood draws, infants excluded for lost contact. 4Only two additional mothers failed their second blood draw. 5At the last anemia assessment, two mothers were excluded for current pregnancy
Figure 2
Figure 2
ROC Curves of Ferritin and ID in Infants. Infant ferritin at 2 months of age is an adequate predictor of infant ID at 6–8 months of age but not of infant ID at 12–18 months. Cut‐points for Fer at younger ages provide indicated Se and Sp for ID at later ages. The dashed line indicates no predictive value. AUC = area under the curve; Fer = ferritin; ID = iron deficiency; ROC = receiver operating characteristic; Se = sensitivity; Sp = specificity
Figure 3
Figure 3
ROC Curves of Ferritin and ID in mothers. Maternal ferritin at 1 month is an adequate predictor of maternal ID at 6–8 months postpartum, and prediction is not changed by adjustment for inflammation. Cut‐points for Fer at 1 month provide indicated Se and Sp for ID at 6–8 months postpartum. The dashed line indicates no predictive value. AUC = area under the curve; Fer = ferritin; ID = iron deficiency; ROC = receiver operating characteristic; Se = sensitivity; Sp = specificity
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