The homozygous hemoglobin EE genotype and chronic inflammation are associated with high serum ferritin and soluble transferrin receptor concentrations among women in rural Cambodia

Crystal D. Karakochuk, Kyly C. Whitfield, Aviva I. Rappaport, Susan I. Barr, Suzanne M. Vercauteren, Judy McLean, Sophonneary Prak, Kroeun Hou, Aminuzzaman Talukder, Robyn Devenish, Timothy J. Green

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Background: Ferritin and soluble transferrin receptor (sTfR) concentrations are commonly used to assess iron deficiency (ID); however, they are influenced by multiple factors. Objectives: We assessed associations between numerous variables and both ferritin and sTfR concentrations in Cambodian women and compared ID prevalence through the use of study-generated correction factors (CFs) for ferritin with those from a published meta-analysis. Methods: Venous blood from 450 women (aged 18-45 y) was assessed for hemoglobin (Hb), ferritin, sTfR, retinol binding protein, folate, vitamin B-12, C-reactive protein, α-1 acid glycoprotein (AGP), and genetic Hb disorders. Linear regression was used to calculate geometric mean ratios (95% CIs) for ferritin and sTfR concentrations. Results: The variant Hb EE genotype was associated with 50% (14%, 96%) and 51% (37%, 66%) higher geometric mean ferritin and sTfR concentrations, respectively, than was the normal Hb AA genotype; a 1-g/L increase in AGP was associated with 99% (50%, 162%) and 48% (33%, 64%) higher concentrations in the same variables, respectively. ID prevalence in nonpregnant women (n = 420) was 2% (n = 9) with the use of ferritin <15 μg/L and 18% (n = 79) with the use of sTfR >8.3 μg/L as criteria. ID prevalence with the use of sTfR was higher in women with the Hb EE genotype (n = 17; 55%) than in those with the Hb AA genotype (n = 20; 10%); and in women with the Hb AA genotype and chronic inflammation (n = 10; 18%) than in that group of women without chronic inflammation (n = 10; 7%) (P < 0.05). No differences in ID prevalence were found with the use of ferritin between women with Hb EE and AA genotypes (P=1.0) or by chronic inflammation status (P=0.32). There were no differences in mean ferritin concentrations among all 450 women when study-generated CFs were compared with those from the meta-analysis (P = 0.87). Conclusions: Compared with sTfR, ferritin concentrations appear to reflect more accurately true ID in rural Cambodian women. The CFs from a published meta-analysis were appropriate for use in this population with a high prevalence of Hb disorders and inflammation.

Original languageEnglish
Pages (from-to)2765-2773
Number of pages9
JournalJournal of Nutrition
Issue number12
Publication statusPublished - 1 Jan 2015


  • Anemia
  • Cambodia
  • Correction factor
  • Ferritin
  • Hemoglobin
  • Inflammation
  • Iron deficiency
  • Soluble transferrin receptor
  • Thalassemia
  • Women

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

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