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Author Notes:

Address correspondence to PSS (e-mail: psuchde@emory.edu).

The author’s responsibilities were as follows—PSS: wrote the manuscript; AMW and SMLN: performed the statistical analyses; and all authors: edited, read, and approved the final manuscript.

We acknowledge the input of the BRINDA working group (Grant J Aaron, O Yaw Addo, Deena Alasfour, Fayrouz A Sakr Ashour, Zulfiqar Bhutta, Reina Engle-Stone, RF-A, Roland Kupka, Leila M Larson, Nino Lortkipanidze, Barbara MacDonald, Purnima Menon, Rebecca Merrill, ZM, SMLN, Christine A Northrop-Clewes, Daniel J Raiten, Pura Rayco-Solon, Rahul Rawat, Fabian Rohner, Ofelia P Saniel, Olga L Sarmiento, Mary Serdula, Saleh Al Shammakhi, PSS, Victor Temple, Andres B Tschannen, AMW, and James P Wirth).

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

The authors alone are responsible for the views expressed in this article, which do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC.


Research Funding:

Supported by the Bill & Melinda Gates Foundation, the CDC, the Global Alliance for Improved Nutrition, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.


  • infection
  • inflammation
  • iron status
  • preschool children
  • serum ferritin
  • soluble transferrin receptor
  • total-body iron stores
  • women of reproductive age

Assessment of iron status in settings of inflammation: challenges and potential approaches.


Journal Title:

American Journal of Clinical Nutrition


Volume 106, Number Suppl 6


, Pages 1626S-1633S

Type of Work:

Article | Final Publisher PDF


The determination of iron status is challenging when concomitant infection and inflammation are present because of confounding effects of the acute-phase response on the interpretation of most iron indicators. This review summarizes the effects of inflammation on indicators of iron status and assesses the impact of a regression analysis to adjust for inflammation on estimates of iron deficiency (ID) in low- and high-infection-burden settings. We overviewed cross-sectional data from 16 surveys for preschool children (PSC) (n = 29,765) and from 10 surveys for nonpregnant women of reproductive age (WRA) (n = 25,731) from the Biomarkers Reflecting the Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Effects of C-reactive protein (CRP) and α1-acid glycoprotein (AGP) concentrations on estimates of ID according to serum ferritin (SF) (used generically to include plasma ferritin), soluble transferrin receptor (sTfR), and total body iron (TBI) were summarized in relation to infection burden (in the United States compared with other countries) and population group (PSC compared with WRA). Effects of the concentrations of CRP and AGP on SF, sTfR, and TBI were generally linear, especially in PSC. Overall, regression correction changed the estimated prevalence of ID in PSC by a median of +25 percentage points (pps) when SF concentrations were used, by -15 pps when sTfR concentrations were used, and by +14 pps when TBI was used; the estimated prevalence of ID in WRA changed by a median of +8 pps when SF concentrations were used, by -10 pps when sTfR concentrations were used, and by +3 pps when TBI was used. In the United States, inflammation correction was done only for CRP concentrations because AGP concentrations were not measured; regression correction for CRP concentrations increased the estimated prevalence of ID when SF concentrations were used by 3 pps in PSC and by 7 pps in WRA. The correction of iron-status indicators for inflammation with the use of regression correction appears to substantially change estimates of ID prevalence in low- and high-infection-burden countries. 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.

Copyright information:

Copyright 2018 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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