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Current or recent malaria infection is associated with elevated inflammation-adjusted ferritin concentrations in
Fanny Sandalinas1, Amy MacDougall1, Suzanne Filteau1
1Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, LondonWC1E 7HT, UK.
Abstract:
Inflammation and infections such as malaria affect micronutrient biomarker concentrations and hence estimates of nutritional status. It is unknown whether correction for C-reactive protein (CRP) and α1-acid glycoprotein (AGP) fully captures the modification in ferritin concentrations during a malaria infection, or whether environmental and sociodemographic factors modify this association. Cross-sectional data from eight surveys in children aged 6-59 months (Cameroon, Cote d'Ivoire, Kenya, Liberia, Malawi, Nigeria and Zambia; n 6653) from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anaemia (BRINDA) project were pooled. Ferritin was adjusted using the BRINDA adjustment method, with values < 12 μg/l indicating iron deficiency. The association between current or recent malaria infection, detected by microscopy or rapid test kit, and inflammation-adjusted ferritin was estimated using pooled multivariable linear regression. Age, sex, malaria endemicity profile (defined by the Plasmodium falciparum infection prevalence) and malaria diagnostic methods were examined as effect modifiers. Unweighted pooled malaria prevalence was 26·0 % (95 % CI 25·0, 27·1) and unweighted pooled iron deficiency was 41·9 % (95 % CI 40·7, 43·1). Current or recent malaria infection was associated with a 44 % (95 % CI 39·0, 52·0; P < 0·001) increase in inflammation-adjusted ferritin after adjusting for age and study identifier. In children, ferritin increased less with malaria infection as age and malaria endemicity increased. Adjustment for malaria increased the prevalence of iron deficiency, but the effect was small. Additional information would help elucidate the underlying mechanisms of the role of endemicity and age in the association between malaria and ferritin.
Insights
Malaria infection increases ferritin levels, a marker affected by inflammation. Adjusting for inflammation and malaria provides a clearer picture of iron status in children, though age and malaria endemicity influence this relationship.
Area of Science:
- Nutritional Epidemiology
- Infectious Disease Research
- Biomarker Analysis
Background:
- Inflammation and infections like malaria can alter micronutrient biomarker concentrations, impacting nutritional status assessments.
- The extent to which inflammation markers (C-reactive protein and α1-acid glycoprotein) fully account for ferritin changes during malaria is unclear.
- Environmental and sociodemographic factors may also modify the association between malaria and ferritin levels.
Purpose of the Study:
- To investigate the association between malaria infection and inflammation-adjusted ferritin concentrations in children.
- To determine if age, sex, malaria endemicity, or diagnostic methods modify the relationship between malaria and ferritin.
- To assess the impact of malaria adjustment on iron deficiency prevalence estimates.
Main Methods:
- Pooled cross-sectional data from 6653 children (6-59 months) across eight African surveys (BRINDA project).
- Ferritin concentrations were adjusted for inflammation using the BRINDA method; iron deficiency defined as ferritin < 12 μg/l.
- Multivariable linear regression analyzed the association between malaria infection (microscopy or rapid test) and adjusted ferritin, examining effect modification.
Main Results:
- Pooled malaria prevalence was 26.0%, and iron deficiency prevalence was 41.9%.
- Malaria infection was associated with a 44% increase in inflammation-adjusted ferritin (P < 0.001).
- The ferritin increase with malaria was attenuated by increasing age and malaria endemicity; adjustment for malaria slightly increased iron deficiency prevalence.
Conclusions:
- Malaria infection significantly elevates inflammation-adjusted ferritin levels in young children.
- Age and malaria endemicity are important effect modifiers in the malaria-ferritin association.
- Further research is needed to understand the mechanisms underlying the influence of endemicity and age on malaria's impact on ferritin.
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