Genetic hemoglobin disorders rather than iron deficiency are a major predictor of hemoglobin concentration in women of reproductive age in rural prey veng, Cambodia

Crystal D. Karakochuk, Kyly C. Whitfield, Susan I. Barr, Yvonne Lamers, Angela M. Devlin, Suzanne M. Vercauteren, Hou Kroeun, Aminuzzaman Talukder, Judy McLean, Timothy J. Green

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Background: Anemia is common in Cambodian women. Potential causes include micronutrient deficiencies, genetic hemoglobin disorders, inflammation, and disease. Objectives: We aimed to investigate factors associated with anemia (low hemoglobin concentration) in rural Cambodian women (18-45 y) and to investigate the relations between hemoglobin disorders and other iron biomarkers. Methods: Blood samples were obtained from 450 women. A complete blood count was conducted, and serum and plasma were analyzed for ferritin, soluble transferrin receptor (sTfR), folate, vitamin B-12, retinol binding protein (RBP), C-reactive protein (CRP), and a1 acid glycoprotein (AGP). Hemoglobin electrophoresis and multiplex polymerase chain reaction were used to determine the prevalence and type of genetic hemoglobin disorders. Results: Overall, 54% of women had a genetic hemoglobin disorder, which included 25 different genotypes (most commonly, hemoglobin E variants and α3.7-thalassemia). Of the 420 nonpregnant women, 29.5% had anemia (hemoglobin <120 g/L), 2% had depleted iron stores (ferritin <15 mg/L), 19% had tissue iron deficiency (sTfR >8.3 μg/L), <3% had folate deficiency (<3 μg/L), and 1%had vitamin B-12 deficiency (<150 pmol/L). Prevalences of iron deficiency anemia (IDA) were 14.2% and 1.5% in those with and without hemoglobin disorders, respectively. There was no biochemical evidence of vitamin A deficiency (RBP <0.7 μmol/L). Acute and chronic inflammation were prevalent among 8% (CRP >5 mg/L) and 26% (AGP >1 g/L) of nonpregnant women, respectively. By using an adjusted linear regression model, the strongest predictors of hemoglobin concentration were hemoglobin E homozygous disorder and pregnancy status. Other predictors were 2 other heterozygous traits (hemoglobin E and Constant Spring), parity, RBP, log ferritin, and vitamin B-12. Conclusions: Multiple biomarkers for anemia and iron deficiency were significantly influenced by the presence of hemoglobin disorders, hence reducing their diagnostic sensitivity. Further investigation of the unexpectedly low prevalence of IDA in Cambodian women is warranted.

LanguageEnglish
Pages134-142
Number of pages9
JournalJournal of Nutrition
Volume145
Issue number1
DOIs
Publication statusPublished - 1 Jan 2015

Keywords

  • Anemia
  • Cambodia
  • Ferritin
  • Hemoglobin
  • Iron deficiency
  • Micronutrient
  • Serum transferrin receptor
  • Thalassemia
  • Women

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Karakochuk, Crystal D. ; Whitfield, Kyly C. ; Barr, Susan I. ; Lamers, Yvonne ; Devlin, Angela M. ; Vercauteren, Suzanne M. ; Kroeun, Hou ; Talukder, Aminuzzaman ; McLean, Judy ; Green, Timothy J. / Genetic hemoglobin disorders rather than iron deficiency are a major predictor of hemoglobin concentration in women of reproductive age in rural prey veng, Cambodia. In: Journal of Nutrition. 2015 ; Vol. 145, No. 1. pp. 134-142.
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abstract = "Background: Anemia is common in Cambodian women. Potential causes include micronutrient deficiencies, genetic hemoglobin disorders, inflammation, and disease. Objectives: We aimed to investigate factors associated with anemia (low hemoglobin concentration) in rural Cambodian women (18-45 y) and to investigate the relations between hemoglobin disorders and other iron biomarkers. Methods: Blood samples were obtained from 450 women. A complete blood count was conducted, and serum and plasma were analyzed for ferritin, soluble transferrin receptor (sTfR), folate, vitamin B-12, retinol binding protein (RBP), C-reactive protein (CRP), and a1 acid glycoprotein (AGP). Hemoglobin electrophoresis and multiplex polymerase chain reaction were used to determine the prevalence and type of genetic hemoglobin disorders. Results: Overall, 54{\%} of women had a genetic hemoglobin disorder, which included 25 different genotypes (most commonly, hemoglobin E variants and α3.7-thalassemia). Of the 420 nonpregnant women, 29.5{\%} had anemia (hemoglobin <120 g/L), 2{\%} had depleted iron stores (ferritin <15 mg/L), 19{\%} had tissue iron deficiency (sTfR >8.3 μg/L), <3{\%} had folate deficiency (<3 μg/L), and 1{\%}had vitamin B-12 deficiency (<150 pmol/L). Prevalences of iron deficiency anemia (IDA) were 14.2{\%} and 1.5{\%} in those with and without hemoglobin disorders, respectively. There was no biochemical evidence of vitamin A deficiency (RBP <0.7 μmol/L). Acute and chronic inflammation were prevalent among 8{\%} (CRP >5 mg/L) and 26{\%} (AGP >1 g/L) of nonpregnant women, respectively. By using an adjusted linear regression model, the strongest predictors of hemoglobin concentration were hemoglobin E homozygous disorder and pregnancy status. Other predictors were 2 other heterozygous traits (hemoglobin E and Constant Spring), parity, RBP, log ferritin, and vitamin B-12. Conclusions: Multiple biomarkers for anemia and iron deficiency were significantly influenced by the presence of hemoglobin disorders, hence reducing their diagnostic sensitivity. Further investigation of the unexpectedly low prevalence of IDA in Cambodian women is warranted.",
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Karakochuk, CD, Whitfield, KC, Barr, SI, Lamers, Y, Devlin, AM, Vercauteren, SM, Kroeun, H, Talukder, A, McLean, J & Green, TJ 2015, 'Genetic hemoglobin disorders rather than iron deficiency are a major predictor of hemoglobin concentration in women of reproductive age in rural prey veng, Cambodia', Journal of Nutrition, vol. 145, no. 1, pp. 134-142. https://doi.org/10.3945/jn.114.198945

Genetic hemoglobin disorders rather than iron deficiency are a major predictor of hemoglobin concentration in women of reproductive age in rural prey veng, Cambodia. / Karakochuk, Crystal D.; Whitfield, Kyly C.; Barr, Susan I.; Lamers, Yvonne; Devlin, Angela M.; Vercauteren, Suzanne M.; Kroeun, Hou; Talukder, Aminuzzaman; McLean, Judy; Green, Timothy J.

In: Journal of Nutrition, Vol. 145, No. 1, 01.01.2015, p. 134-142.

Research output: Contribution to journalArticle

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T1 - Genetic hemoglobin disorders rather than iron deficiency are a major predictor of hemoglobin concentration in women of reproductive age in rural prey veng, Cambodia

AU - Karakochuk, Crystal D.

AU - Whitfield, Kyly C.

AU - Barr, Susan I.

AU - Lamers, Yvonne

AU - Devlin, Angela M.

AU - Vercauteren, Suzanne M.

AU - Kroeun, Hou

AU - Talukder, Aminuzzaman

AU - McLean, Judy

AU - Green, Timothy J.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background: Anemia is common in Cambodian women. Potential causes include micronutrient deficiencies, genetic hemoglobin disorders, inflammation, and disease. Objectives: We aimed to investigate factors associated with anemia (low hemoglobin concentration) in rural Cambodian women (18-45 y) and to investigate the relations between hemoglobin disorders and other iron biomarkers. Methods: Blood samples were obtained from 450 women. A complete blood count was conducted, and serum and plasma were analyzed for ferritin, soluble transferrin receptor (sTfR), folate, vitamin B-12, retinol binding protein (RBP), C-reactive protein (CRP), and a1 acid glycoprotein (AGP). Hemoglobin electrophoresis and multiplex polymerase chain reaction were used to determine the prevalence and type of genetic hemoglobin disorders. Results: Overall, 54% of women had a genetic hemoglobin disorder, which included 25 different genotypes (most commonly, hemoglobin E variants and α3.7-thalassemia). Of the 420 nonpregnant women, 29.5% had anemia (hemoglobin <120 g/L), 2% had depleted iron stores (ferritin <15 mg/L), 19% had tissue iron deficiency (sTfR >8.3 μg/L), <3% had folate deficiency (<3 μg/L), and 1%had vitamin B-12 deficiency (<150 pmol/L). Prevalences of iron deficiency anemia (IDA) were 14.2% and 1.5% in those with and without hemoglobin disorders, respectively. There was no biochemical evidence of vitamin A deficiency (RBP <0.7 μmol/L). Acute and chronic inflammation were prevalent among 8% (CRP >5 mg/L) and 26% (AGP >1 g/L) of nonpregnant women, respectively. By using an adjusted linear regression model, the strongest predictors of hemoglobin concentration were hemoglobin E homozygous disorder and pregnancy status. Other predictors were 2 other heterozygous traits (hemoglobin E and Constant Spring), parity, RBP, log ferritin, and vitamin B-12. Conclusions: Multiple biomarkers for anemia and iron deficiency were significantly influenced by the presence of hemoglobin disorders, hence reducing their diagnostic sensitivity. Further investigation of the unexpectedly low prevalence of IDA in Cambodian women is warranted.

AB - Background: Anemia is common in Cambodian women. Potential causes include micronutrient deficiencies, genetic hemoglobin disorders, inflammation, and disease. Objectives: We aimed to investigate factors associated with anemia (low hemoglobin concentration) in rural Cambodian women (18-45 y) and to investigate the relations between hemoglobin disorders and other iron biomarkers. Methods: Blood samples were obtained from 450 women. A complete blood count was conducted, and serum and plasma were analyzed for ferritin, soluble transferrin receptor (sTfR), folate, vitamin B-12, retinol binding protein (RBP), C-reactive protein (CRP), and a1 acid glycoprotein (AGP). Hemoglobin electrophoresis and multiplex polymerase chain reaction were used to determine the prevalence and type of genetic hemoglobin disorders. Results: Overall, 54% of women had a genetic hemoglobin disorder, which included 25 different genotypes (most commonly, hemoglobin E variants and α3.7-thalassemia). Of the 420 nonpregnant women, 29.5% had anemia (hemoglobin <120 g/L), 2% had depleted iron stores (ferritin <15 mg/L), 19% had tissue iron deficiency (sTfR >8.3 μg/L), <3% had folate deficiency (<3 μg/L), and 1%had vitamin B-12 deficiency (<150 pmol/L). Prevalences of iron deficiency anemia (IDA) were 14.2% and 1.5% in those with and without hemoglobin disorders, respectively. There was no biochemical evidence of vitamin A deficiency (RBP <0.7 μmol/L). Acute and chronic inflammation were prevalent among 8% (CRP >5 mg/L) and 26% (AGP >1 g/L) of nonpregnant women, respectively. By using an adjusted linear regression model, the strongest predictors of hemoglobin concentration were hemoglobin E homozygous disorder and pregnancy status. Other predictors were 2 other heterozygous traits (hemoglobin E and Constant Spring), parity, RBP, log ferritin, and vitamin B-12. Conclusions: Multiple biomarkers for anemia and iron deficiency were significantly influenced by the presence of hemoglobin disorders, hence reducing their diagnostic sensitivity. Further investigation of the unexpectedly low prevalence of IDA in Cambodian women is warranted.

KW - Anemia

KW - Cambodia

KW - Ferritin

KW - Hemoglobin

KW - Iron deficiency

KW - Micronutrient

KW - Serum transferrin receptor

KW - Thalassemia

KW - Women

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DO - 10.3945/jn.114.198945

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JO - Journal of Nutrition

T2 - Journal of Nutrition

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