The magnitude and distribution across countries of iron deficiency using serum/plasma ferritin

Main Article Content

Zuguo Mei Laurence M. Grummer-Strawn

Abstract

Background: In 2004, World Health Organization (WHO) recommended the use of serum ferritin as a primary indicator of iron deficiency. However, there was limited data on the magnitude and distribution of iron deficiency based on ferritin.


Objective: To describe the prevalence of iron deficiency as measured by serum/plasma ferritin in different regions of the world and its relationship with demographic and health indicators.


Methods: Data from the Biomarkers Reflecting Inflammation and Nutrition Determinants of Anemia and the WHO Vitamin and Mineral Nutrition Information System Micronutrients Database were used for this analysis. Unadjusted and inflammation-adjusted low ferritin prevalence were calculated for both databases. The prevalence of low ferritin among preschool children and non-pregnant women was examined according to its relationship with national gross domestic product (GDP), infant mortality rate (IMR), and anemia rate.


Results: In children, the median inflammation-adjusted prevalence of low ferritin was 35.3% (1st and 3rd quartiles: 17.5% and 48.1%). In non-pregnant women, the median inflammation-adjusted prevalence of low ferritin was 28.4% (1st and 3rd quartiles: 21.4% and 42.0%). For both children and women, the correlation between the prevalence of low ferritin and GDP, IMR, or anemia was consistently stronger using inflammation-adjusted prevalences than when using unadjusted prevalences.


Conclusions: The quartile values of low ferritin prevalence for children and non-pregnant women could be used to define the severity of ferritin as a public health problem.

Keywords: ferritin, iron deficiency, public health significance, children, women

Article Details

How to Cite
MEI, Zuguo; GRUMMER-STRAWN, Laurence M.. The magnitude and distribution across countries of iron deficiency using serum/plasma ferritin. Medical Research Archives, [S.l.], v. 7, n. 12, dec. 2019. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2027>. Date accessed: 22 dec. 2024. doi: https://doi.org/10.18103/mra.v7i12.2027.
Section
Research Articles

References

1. Mei Z, Cogswell M, Parvanta I, Lynch S, Beard J, Stolzfus R, Gruummer-Strawn L. Hemoglobin and Ferritin Are Currently the Most Efficient Indicators of Population Response to Iron Interventions: an Analysis of Nine Randomized Controlled Trials. J Nutr 2005;135:1974–1980.
2. World Health Organization/Centers for Disease Control and Prevention. Assessing the iron status of populations: including literature reviews. report of a Joint World Health Organization/Centers for Disease Control and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level, Geneva, Switzerland, 6–8 April 2004. 2nd edition 2007.
3. De Onis M, Bloessner M. WHO Global Database on Child Growth and Malnutrition. Geneva, World Health Organization. 1997. WHO/NUT/97.4 Available at http://whqlibdoc.who.int/hq/1997/WHO_NUT_97.4.pdf
4. World Health Organization (WHO). Indicators for assessing vitamin A Deficiency and their application in monitoring and evaluating intervention programs. Geneva: World Health Organization. 1996; (WHO/NUT/96.10).
5. World Health Organization (WHO). The management of nutrition in major emergencies. Geneva, World Health Organization, 2000. Available at http://whqlibdoc.who.int/publications/2000/9241545208.pdf.
6. World Health Organization (WHO). Iron deficiency anemia - Assessment, prevention, and control: A guide for program managers. Geneva: World Health Organization. 2001; (WHO/NHD/01.3).
7. Namaste SML, Aaron GJ; Varadhan R; Peerson JM; Suchdev PS. Methodologic approach for the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) Project. Am J Clin Nutr 2017;106(Suppl):333S-347S.
8. Namaste SML, Rohner F, Huang J, Bhushan NL, Flores-Ayala R, Kupka R, Mei Z, Rawat R, Williams AM, Raiten DJ, et al. Adjusting ferritin concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Am J Clin Nutr 2017;106(Suppl):359S-371S.
9. World Health Organization (WHO). Vitamin and Mineral Nutrition Information System (VMNIS). Available at http://www.who.int/vmnis/en/.
10. Erhardt JG, Estes JE, Pfeiffer CM, Biesalski HK, Craft NE. Combined measurement of ferritin, soluble transferrin receptor, retinol binding protein, and C-reactive protein by an inexpensive, sensitive, and simple sandwich enzyme-linked immunosorbent assay technique. J Nutr 2004;134:3127-32.
11. World Health Organization. Micronutrient deficiencies: iron deficiency anaemia. Available at www.who.int/nutrition/topics/ida/en/.
12. Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR,Branca F, Peña-Rosas JP, Bhutta ZA, Ezzati M, on behalf of Nutrition Impact Model Study Group (Anaemia). Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995-2011: a systematic analysis of population-representative data. Lancet Glob Health 2013;1(1):e16–25.
13. Tomkins A. Assessing micronutrient status in the presence of inflammation. J Nutr 2003;133:1649S-1655S.
14. Thurnham DI, McCabe LD, Haldar S, Wieringa FT, Northrop-Clewes CA, McCabe GP. Adjusting plasma ferritin concentrations to remove the effects of subclinical inflammation in the assessment of iron deficiency: a meta-analysis. Am J Clin Nutr 2011;92:546-55.
15. Engle-Stone R, Nankap M, Ndjebayi AO, Erhardt JG, Brown KH. Plasma ferritin and soluble transferrin receptor concentrations and body iron stores identify similar risk factors for iron deficiency but result in different estimates of the national prevalence of iron deficiency and iron-deficiency anemia among women and children in Cameroon. J Nutr 2012;143:369-77.
16. Righetti AA, Wegmuller R, Glinz D, et al. Effects of inflammation and Plasmodium falciparum infection on soluble transferrin receptor and plasma ferritin concentration in different age groups: a prospective longitudinal study in Cote d'Ivoire. Am J Clin Nutr 2013;97:1364-74.
17. de Onis M, Borghi E, Arimond M, Webb P, Croft T, Saha K, De-Regil LM, Thuita F, Heidkamp R, Krasevec J, Hayashi C, Flores-Ayala R. Prevalence thresholds for wasting, overweight and stunting in children under 5 years. Public Health Nutr 2019;22(1):175-179.