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Age- and sex-specific reference intervals for trace elements in infants and children: a multi-center study in
Junqiang Li1, Zhongguo Chen1, Xuezu Zhang2
1Department of Neonatology, Lincang Maternity and Child Health Hospital, Lincang, China.
Insights
This study establishes age- and sex-specific reference intervals (RIs) for essential trace elements in children. The findings provide crucial data for accurate blood analysis in pediatric health assessments.
Area of Science:
- Clinical Chemistry
- Pediatric Health
- Trace Element Analysis
Background:
- Reference intervals (RIs) for trace elements are crucial for pediatric health.
- Existing RIs may not accurately reflect age- and sex-specific variations in children.
- Data were collected from three health screening centers.
Purpose of the Study:
- To determine age- and sex-specific reference intervals (RIs) for copper, zinc, calcium, magnesium, iron, and lead in blood for children.
- To develop a robust algorithm for calculating these RIs.
- To provide a global reference for laboratories.
Main Methods:
- Utilized data from 3933 pediatric outpatients (<18 years).
- Employed atomic absorption spectrometry for trace element measurement.
- Applied Classification and Regression Tree (CART) and refineR algorithms for age segmentation and RI calculation, validated by Harris-Boyd and Lahti methods.
Main Results:
- Established RIs for six trace elements (copper, zinc, calcium, magnesium, iron, lead) across age subgroups from 1 month to 18 years.
- Observed significant age-related trends: decreasing copper and calcium, increasing zinc and iron with age.
- Noted a peak in blood lead levels around 15 years in both sexes, while magnesium remained stable.
Conclusions:
- Successfully established age- and sex-specific reference intervals for six key trace elements in children.
- The refineR algorithm and segmentation methods offer a reliable approach for laboratories worldwide.
- These RIs will aid in the accurate interpretation of trace element status in pediatric populations.
Background:
We used an algorithm to determine age- and sex-specific reference intervals (RIs) for copper, zinc, calcium, magnesium, iron, and lead in blood. Data were collected from three health screening centers.
Methods:
The data were obtained from the trace element test results of 3933 outpatients aged <18 years at three health examination centers in Lincang City between June 2014 and May 2024. Atomic absorption spectrometry was employed to measure the trace element. Participants were divided into subgroups at 1-year intervals according to age and gender. Decision trees were constructed by the Classification and Regression Tree method to determine the optimal age segmentation point. Harris-Boyd and Lahti methods were used to assess the appropriateness of age segmentation.
Results:
After the appropriate segmentation points are determined, the refineR algorithm is applied to calculate RIs. After data cleaning, 3933 samples were analyzed for age subgroup partitioning of trace elements from 1 month through 18 years. The difference between the age sub-groups was statistically significant according to the Harris-Boyd method and the Lahti method. Blood copper and calcium levels gradually decreased with months and blood zinc and iron concentration gradually increased with months. After gradually decreasing with months, blood pb levels in boys and girls tended to peak at 15 years and beyond. Blood magnesium levels remained stable.
Conclusions:
We have established RIs for six trace elements for children, and the methods we use provide reference for laboratories around the world.
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