By Sheela Sinharoy
The EB 2015 program is online! A highlight for me will be the symposium Approaches to Account for the Effects of Inflammation on Nutrient Biomarkers: Nutrition Determinants of Anemia (BRINDA) project, scheduled for Monday, March 30 at 3:00 pm. BRINDA has brought together data from 15 countries, accessing surveys that include preschool children, school age children, and women of reproductive age, to examine the relationship between inflammation, nutrition biomarkers, and anemia.
Although many of us think of iron when we think of anemia – and it is widely accepted that iron deficiency is the major cause of anemia worldwide – we also know that there are many other factors influencing hemoglobin levels. Deficiencies of vitamins A, C, E, B6, B12, riboflavin, folate, copper, and zinc can all cause anemia through varied biological mechanisms. Other important factors affecting hemoglobin include inflammation, chronic disease, infection with parasites, and hemoglobinopathies.
Inflammation not only causes anemia but also affects the biomarkers that are used to measure anemia and nutrient status. Hemoglobin itself is influenced by inflammation: just as smoking and high altitudes lead to decreased oxygen levels in the blood, inflammation has a similar effect, increasing hemoglobin concentrations. Similarly, ferritin is commonly used to measure iron status, but ferritin increases in the acute phase response (APR). Retinol binding protein, which is used to measure vitamin A, decreases in the APR. Thus, inflammation can distort estimates, making it difficult to measure the actual prevalence of anemia or nutrient deficiencies. Initial findings from BRINDA suggest that inflammation is common across the sample and should be taken into consideration when measuring nutrient status.
What can be done about this? How can nutrition programs account for inflammation when measuring nutrient status? Is there a correction factor that one can apply to the standard measurements? How can programs most reliably estimate the etiology of anemia in their target populations? Given the prevalence of anemia worldwide, it is crucial to have a better understanding of its risk factors and approaches to measure them. The symposium will address these questions.
The topics above will be further addressed in two minisymposia on March 31: the Medical Nutrition Council’s “Nutrition and Inflammation” at 10:30 am and the Global Nutrition Council’s “Advances in Biomarker Development and Use” from 3:00-5:00 pm. In the first session, Leila Larson and Yaw Addo will share findings from BRINDA on specific methods to account for inflammation when measuring retinol binding protein for vitamin A and transferrin receptor for iron status. In the second, Rebecca Merrill will present data on the prevalence of inflammation among preschool children across twelve countries and its association with growth. These presentations from the BRINDA team can have wide-ranging implications and will be of interest to policy makers, program implementers, and academic researchers alike.