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

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

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.

LanguageEnglish
Pages2765-2773
Number of pages9
JournalJournal of Nutrition
Volume145
Issue number12
DOIs
Publication statusPublished - 1 Jan 2015

Keywords

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

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Karakochuk, Crystal D. ; Whitfield, Kyly C. ; Rappaport, Aviva I. ; Barr, Susan I. ; Vercauteren, Suzanne M. ; McLean, Judy ; Prak, Sophonneary ; Hou, Kroeun ; Talukder, Aminuzzaman ; Devenish, Robyn ; Green, Timothy J. / The homozygous hemoglobin EE genotype and chronic inflammation are associated with high serum ferritin and soluble transferrin receptor concentrations among women in rural Cambodia. In: Journal of Nutrition. 2015 ; Vol. 145, No. 12. pp. 2765-2773.
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abstract = "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.",
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author = "Karakochuk, {Crystal D.} and Whitfield, {Kyly C.} and Rappaport, {Aviva I.} and Barr, {Susan I.} and Vercauteren, {Suzanne M.} and Judy McLean and Sophonneary Prak and Kroeun Hou and Aminuzzaman Talukder and Robyn Devenish and Green, {Timothy J.}",
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Karakochuk, CD, Whitfield, KC, Rappaport, AI, Barr, SI, Vercauteren, SM, McLean, J, Prak, S, Hou, K, Talukder, A, Devenish, R & Green, TJ 2015, 'The homozygous hemoglobin EE genotype and chronic inflammation are associated with high serum ferritin and soluble transferrin receptor concentrations among women in rural Cambodia', Journal of Nutrition, vol. 145, no. 12, pp. 2765-2773. https://doi.org/10.3945/jn.115.218636

The homozygous hemoglobin EE genotype and chronic inflammation are associated with high serum ferritin and soluble transferrin receptor concentrations among women in rural Cambodia. / Karakochuk, Crystal D.; Whitfield, Kyly C.; Rappaport, Aviva I.; Barr, Susan I.; Vercauteren, Suzanne M.; McLean, Judy; Prak, Sophonneary; Hou, Kroeun; Talukder, Aminuzzaman; Devenish, Robyn; Green, Timothy J.

In: Journal of Nutrition, Vol. 145, No. 12, 01.01.2015, p. 2765-2773.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The homozygous hemoglobin EE genotype and chronic inflammation are associated with high serum ferritin and soluble transferrin receptor concentrations among women in rural Cambodia

AU - Karakochuk, Crystal D.

AU - Whitfield, Kyly C.

AU - Rappaport, Aviva I.

AU - Barr, Susan I.

AU - Vercauteren, Suzanne M.

AU - McLean, Judy

AU - Prak, Sophonneary

AU - Hou, Kroeun

AU - Talukder, Aminuzzaman

AU - Devenish, Robyn

AU - Green, Timothy J.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - 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.

AB - 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.

KW - Anemia

KW - Cambodia

KW - Correction factor

KW - Ferritin

KW - Hemoglobin

KW - Inflammation

KW - Iron deficiency

KW - Soluble transferrin receptor

KW - Thalassemia

KW - Women

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DO - 10.3945/jn.115.218636

M3 - Article

VL - 145

SP - 2765

EP - 2773

JO - Journal of Nutrition

T2 - Journal of Nutrition

JF - Journal of Nutrition

SN - 0022-3166

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ER -