Iron, zinc, vitamin A and selenium status in a cohort of Indonesian infants after adjusting for inflammation using several different approaches

Br J Nutr. 2017 Nov;118(10):830-839. doi: 10.1017/S0007114517002860.


Inflammation confounds the interpretation of several micronutrient biomarkers resulting in estimates that may not reflect the true burden of deficiency. We aimed to assess and compare the micronutrient status of a cohort of Indonesian infants (n 230) at aged 6, 9 and 12 months by ignoring inflammation (unadjusted) and adjusting four micronutrient biomarkers for inflammation with C-reactive protein (CRP) and α-1-glycoprotein (AGP) using the following methods: (1) arithmetic correction factors with the use of a four-stage inflammation model; and (2) regression modelling. Prevalence of infants with any inflammation (CRP>5 mg/l and/or AGP>1 g/l) was about 25% at each age. Compared with unadjusted values, regression adjustment at 6, 9 and 12 months generated the lowest (P50 % across all ages. In conclusion, without inflammation adjustment, Fe deficiency was grossly under-estimated and vitamin A and Zn deficiency over-estimated, highlighting the importance of correcting for the influence of such, before implementing programmes to alleviate micronutrient malnutrition. However, further work is needed to validate the proposed approaches with a particular focus on assessing the influence of varying degrees of inflammation (i.e. recurrent acute infections and low-grade chronic inflammation) on each affected nutrient biomarker.

Keywords: AGP α-1-glycoprotein; APP acute phase proteins; BRINDA Biomarkers Reflecting Inflammation and Nutritional Determinants Anemia; CRP C-reactive protein; GM geometric mean; RBP retinol-binding protein; sTfR soluble transferrin receptor; Biomarkers; Indonesia; Inflammations; Iron; Selenium; Vitamin A; Zinc.

MeSH terms

  • Anemia, Iron-Deficiency / blood
  • Anemia, Iron-Deficiency / epidemiology
  • Biomarkers / blood
  • C-Reactive Protein / metabolism
  • Cohort Studies
  • Cross-Sectional Studies
  • Deficiency Diseases / blood*
  • Deficiency Diseases / epidemiology
  • Female
  • Ferritins / blood
  • Humans
  • Indonesia / epidemiology
  • Infant
  • Inflammation / blood*
  • Inflammation / complications
  • Inflammation / epidemiology
  • Iron / blood*
  • Iron Deficiencies
  • Male
  • Micronutrients / blood
  • Nutritional Status*
  • Orosomucoid / metabolism
  • Prevalence
  • Retinol-Binding Proteins / metabolism
  • Selenium / blood*
  • Selenium / deficiency
  • Vitamin A / blood*
  • Vitamin A Deficiency / blood
  • Vitamin A Deficiency / epidemiology
  • Zinc / blood*
  • Zinc / deficiency


  • Biomarkers
  • Micronutrients
  • Orosomucoid
  • Retinol-Binding Proteins
  • Vitamin A
  • C-Reactive Protein
  • Ferritins
  • Iron
  • Selenium
  • Zinc