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Author Notes:

Address correspondence to FR (e-mail: fabian@groundworkhealth.org).

The author’s responsibilities were as follows—FR: conceptualized the data analysis, assisted in the data analysis, interpreted the data, and drafted the manuscript

SMLN: managed the data, carried out the data analysis, and aided in the interpretation and drafting of the manuscript

LML: cross-checked the data analysis

OYA, ZM, PSS, AMW, FASA, RR, and DJR: contributed to the drafting of the manuscript

CAN-C: assisted in the data interpretation and drafting of the manuscript

All authors: read and approved the final manuscript as submitted.

We thank Ravi Varadhan, Jin Huan, and Janet M Peerson for contributing to the statistical approach and Juergen Ehardt, Donnie Whitehead, Kelley Scanlon, Deborah Galuska, David Thurnham, Richard Hurrell, and Sean Lynch for sharing their inputs.

For their contributions, we thank the BRINDA steering committee [Grant J Aaron, Rafael Flores-Ayala, SMLN, DJR, and PSS (chair)] and the BRINDA working group (OYA, Deena Alasfour, FASA, Zulfiqar Bhutta, Reina Engle-Stone, Roland Kupka, LML, Nino Lortkipanidze, Barbara MacDonald, Purnima Menon, Rebecca Merrill, ZM, CAN-C, Pura Rayco-Solon, Rahul Rawat, FR, Ofelia P Saniel, Olga L Sarmiento, Mary Serdula, Saleh Al Shammakhi, Victor Temple, Andres B Tschannen, AMW, and James P Wirth).

None of the authors reported a conflict of interest related to the study.



  • Science & Technology
  • Life Sciences & Biomedicine
  • Nutrition & Dietetics
  • anemia
  • inflammation
  • iron deficiency
  • nutritional assessment
  • soluble transferrin receptor

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

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Journal Title:

American Journal of Clinical Nutrition


Volume 106, Number 1


, Pages 372S-382S

Type of Work:

Article | Final Publisher PDF


Background: Iron deficiency is thought to be one of the most prevalent micronutrient deficiencies globally, but an accurate assessment in populations who are frequently exposed to infections is impeded by the inflammatory response, which causes iron-biomarker alterations. Objectives: We assessed the relation between soluble transferrin receptor (sTfR) concentrations and inflammation and malaria in preschool children (PSC) (age range: 6-59 mo) and women of reproductive age (WRA) (age range: 15-49 y) and investigated adjustment algorithms to account for these effects. Design: Cross-sectional data from the Biomarkers Reflecting the Inflammation and Nutritional Determinants of Anemia (BRINDA) project from 11,913 PSC in 11 surveys and from 11,173 WRA in 7 surveys were analyzed individually and combined with the use of a meta-analysis. The following 3 adjustment approaches were compared with estimated iron-deficient erythropoiesis (sTfR concentration > 8.3 mg/L): 1) the exclusion of individuals with C-reactive protein (CRP) concentrations > 5 mg/L or α-1-acid glycoprotein (AGP) concentrations > 1 g/L, 2) the application of arithmetic correction factors, and 3) the use of regression approaches. Results: The prevalence of elevated sTfR concentrations incrementally decreased as CRP and AGP deciles decreased for PSC and WRA, but the effect was more pronounced for AGP than for CRP. Depending on the approach used to adjust for inflammation, the estimated prevalence of iron-deficient erythropoiesis decreased by 4.4-14.6 and 0.3-9.5 percentage points in PSC and WRA, respectively, compared with unadjusted values. The correction-factor approach yielded a more modest reduction in the estimated prevalence of iron-deficient erythropoiesis than did the regression approach. Mostly, adjustment for malaria in addition to AGP did not significantly change the estimated prevalence of iron-deficient erythropoiesis. Conclusions: sTfR may be useful to assess iron-deficient erythropoiesis, but inflammation influences its interpretation, and adjustment of sTfR for inflammation and malaria should be considered. More research is warranted to evaluate the proposed approaches in different settings, but this study contributes to the evidence on how and when to adjust sTfR for inflammation and malaria.

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© 2017 by the American Society for Nutrition

This is an Open Access work distributed under the terms of the Creative Commons Attribution 3.0 Unported License (http://creativecommons.org/licenses/by/3.0/).

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