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Inflammation and Micronutrient Status of Children and Adolescents in 12 Countries Are Only Weakly Associated: The
Jiaxi Geng1, Madeleine Zeiler1, E Rochelle Werner1
1Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
Insights
Inflammation does not significantly impact micronutrient deficiency estimates in children. This study found weak associations between inflammation biomarkers and levels of folate, vitamin B12, vitamin D, and zinc in children aged 5-19 years.
Area of Science:
- Nutritional Science
- Pediatric Health
- Biochemistry
Background:
- Inflammation can potentially skew the assessment of micronutrient deficiencies.
- Limited research exists on the extent and nature of this bias in school-aged children and adolescents.
Purpose of the Study:
- To investigate the relationship between inflammation biomarkers (C-reactive protein and α-1-acid-glycoprotein) and key micronutrient status in children aged 5-19 years.
- To determine if inflammation influences the estimation of deficiencies in folate, vitamin B12, vitamin D, and zinc.
Main Methods:
- Analysis of data from 13 cross-sectional surveys involving 46,363 children across 12 countries.
- Calculation of Spearman rank correlations between inflammation markers (CRP, AGP) and micronutrient biomarkers (serum folate, RBC folate, vitamin B12, 25(OH)D, zinc).
- Examination of dose-response relationships by plotting micronutrient geometric means across deciles of inflammation markers, stratified by age.
Main Results:
- Prevalence of inflammation varied across surveys (2.7-29.6%).
- Micronutrient deficiencies were prevalent, with ranges varying widely by nutrient.
- Weak and inconsistent correlations (absolute r < 0.2) were observed between inflammation biomarkers and micronutrient levels, with no clear patterns.
Conclusions:
- The observed weak and inconsistent associations do not support routine adjustment for inflammation when assessing deficiencies of folate, vitamin B12, vitamin D, or zinc in children aged 5-19 years.
- Current methods for estimating these micronutrient deficiencies in pediatric populations do not require inflammation correction.
Background:
Inflammation may bias the estimation of burden of certain micronutrient deficiencies; however, few studies have examined the magnitude and direction of this bias in school-age children and adolescents.
Objectives:
Associations between biomarkers of inflammation [C-reactive protein (CRP) and α-1-acid-glycoprotein (AGP)] and multiple micronutrient biomarkers [serum folate (SFO), red blood cell folate (RBC folate), serum vitamin B12, serum 25(OH)D, and serum zinc] were examined in children aged 5 to 19 y.
Methods:
This analysis included 13 cross-sectional surveys of children (n = 46,363) from 12 countries with ≥1 micronutrient biomarker of interest, CRP or AGP, and n > 100 per survey. Spearman rank correlations between each micronutrient and inflammation biomarker were calculated by survey. To examine the dose-response relationship between inflammation and micronutrient levels, geometric means of each micronutrient biomarker were plotted across deciles of AGP and CRP, stratified by age groups (5-9, 10-14, and 15-19 y), and overall (5-19 y).
Results:
Prevalence of inflammation (CRP >5 mg/L or AGP >1 g/L) ranged from 2.7% to 29.6% by survey with medians ranging from 0.5 to 0.8 g/L for AGP and 0.2 to 1.9 mg/L for CRP. The prevalence of micronutrient deficiencies ranged from 0.1% to 87.7% for SFO, 0.1% to 24.4% for RBC folate, 0.5% to 54.8% for vitamin B12, 4.6% to 25.6% for serum 25(OH)D, and 0.6% to 57.3% for zinc, with median values from 4.2 to 45.5 nmol/L for SFO, 452.1 to 1000.0 nmol/L for RBC folate, 131 to 442 pmol/L for vitamin B12, 43.2 to 60.0 nmol/L for serum 25(OH)D, and 59.4 to 92.9 μg/dL for zinc. Associations between micronutrient biomarkers and AGP or CRP were weak (most absolute r < 0.2) with no clear pattern across positive, negative, and null associations. Geometric means of micronutrient biomarkers did not show clear patterns of association with CRP or AGP deciles, overall or stratified by sex or age group.
Conclusions:
With weak and inconsistent correlations between inflammation and select micronutrient biomarkers, these findings do not support the routine adjustment for inflammation when estimating folate, vitamin B12, vitamin D, or zinc deficiencies in children aged 5 to 19 y.
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