Background - The first 1000 days of life (from conception to two years of age) is a critical period of nutritional vulnerability, affecting lifelong health. Iron deficiency (ID) and iron deficiency anaemia (IDA) are considered major public health problems that adversely affect development and growth, impair immunity, and increase morbidity and mortality in infants. ID and IDA in sub-Saharan Africa can be attributed to poor dietary, socioeconomic and disease conditions. One of the major obstacles in determining the prevalence of ID, using serum ferritin (SF) as marker of iron status, is that it not only reflects the amount of iron that is stored in the body, but also functions as an acute phase reactant that is raised in the presence of infection or inflammation. Aim - We conducted a re-analysis of the International Research on Infant Supplementation (IRIS) study’s baseline data to determine a more accurate estimation of the ID prevalence in apparently healthy four to thirteen-month-old infants from rural KwaZulu-Natal while accounting for the effect of chronic and acute inflammation on SF. Study design and methods - A cross-sectional analysis was performed on the baseline data (192 infants) of the IRIS study that was conducted in 2000. Infants’ haemoglobin (Hb), SF, C-reactive protein (CRP) and alpha-1 glycoprotein (AGP) concentrations were interpreted to determine the prevalence of ID. Literature of the past four years served as a guide to compare the ID prevalence obtained from four methods that account for the influence of inflammation on SF concentrations, to a reference method that does not take inflammation into consideration, and to what was reported in the original IRIS study. Weight and recumbent length measurements were converted to z-scores to interpret subjects’ anthropometric nutritional status. Results - A high prevalence of inflammation (52.6%) was present, with 11.5% of the subjects being in the incubation, 17.2% in the early convalescent, and 24% in the late convalescent phase of inflammation. SF was significantly associated with both CRP (ß = 0.200; P = 0.005) and AGP (ß = 0.223; P = 0.002) when adjusting for gender and age. The IRIS study reported an ID prevalence of 18.3%, whereas the results of this study ranged from 17.2 to 52.1%. We derived an IDA prevalence that ranged from 12 to 24.5% according to the different methods. The prevalence of stunting [length-for-age Z-score <-2SD] was 12.5%; while 25.1% of infants were overweight/obese [weight-for-length z-score >2SD]. Conclusion - A double burden of malnutrition was evident from the high prevalence of both overweight and ID, together with inflammation. The disconcertingly large variance in ID prevalence observed between the different methods that were employed highlights that iron supplementation interventions to treat anaemia must be based upon accurate estimates of IDA prevalence, otherwise they pose an increased risk of adverse effects to susceptible, iron-replete, but anaemic infants. Given the detrimental consequences of ID, it is imperative that governments, health care providers and parents must act to prevent or treat ID and IDA among vulnerable infants. / MSc (Dietetics), North-West University, Potchefstroom Campus, 2014

Background - The first 1000 days of life (from conception to two years of age) is a critical period of nutritional vulnerability, affecting lifelong health. Iron deficiency (ID) and iron deficiency anaemia (IDA) are considered major public health problems that adversely affect development and growth, impair immunity, and increase morbidity and mortality in infants. ID and IDA in sub-Saharan Africa can be attributed to poor dietary, socioeconomic and disease conditions. One of the major obstacles in determining the prevalence of ID, using serum ferritin (SF) as marker of iron status, is that it not only reflects the amount of iron that is stored in the body, but also functions as an acute phase reactant that is raised in the presence of infection or inflammation. Aim - We conducted a re-analysis of the International Research on Infant Supplementation (IRIS) study’s baseline data to determine a more accurate estimation of the ID prevalence in apparently healthy four to thirteen-month-old infants from rural KwaZulu-Natal while accounting for the effect of chronic and acute inflammation on SF. Study design and methods - A cross-sectional analysis was performed on the baseline data (192 infants) of the IRIS study that was conducted in 2000. Infants’ haemoglobin (Hb), SF, C-reactive protein (CRP) and alpha-1 glycoprotein (AGP) concentrations were interpreted to determine the prevalence of ID. Literature of the past four years served as a guide to compare the ID prevalence obtained from four methods that account for the influence of inflammation on SF concentrations, to a reference method that does not take inflammation into consideration, and to what was reported in the original IRIS study. Weight and recumbent length measurements were converted to z-scores to interpret subjects’ anthropometric nutritional status. Results - A high prevalence of inflammation (52.6%) was present, with 11.5% of the subjects being in the incubation, 17.2% in the early convalescent, and 24% in the late convalescent phase of inflammation. SF was significantly associated with both CRP (ß = 0.200; P = 0.005) and AGP (ß = 0.223; P = 0.002) when adjusting for gender and age. The IRIS study reported an ID prevalence of 18.3%, whereas the results of this study ranged from 17.2 to 52.1%. We derived an IDA prevalence that ranged from 12 to 24.5% according to the different methods. The prevalence of stunting [length-for-age Z-score <-2SD] was 12.5%; while 25.1% of infants were overweight/obese [weight-for-length z-score >2SD]. Conclusion - A double burden of malnutrition was evident from the high prevalence of both overweight and ID, together with inflammation. The disconcertingly large variance in ID prevalence observed between the different methods that were employed highlights that iron supplementation interventions to treat anaemia must be based upon accurate estimates of IDA prevalence, otherwise they pose an increased risk of adverse effects to susceptible, iron-replete, but anaemic infants. Given the detrimental consequences of ID, it is imperative that governments, health care providers and parents must act to prevent or treat ID and IDA among vulnerable infants. / MSc (Dietetics), North-West University, Potchefstroom Campus, 2014

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Background The potential dire consequences of iron deficiency (ID) and iron deficiency anaemia (IDA) on childhood development are of major public health concern. Many factors contribute to anaemia, ID being only one progressive factor. The prevalence of ID and IDA must be accurately determined before iron intervention strategies can be safely prescribed. There is continued uncertainty regarding the optimal approach to identifying and measuring ID, as indicators have different roles, explore different aspects of iron metabolism and cannot be directly compared. Furthermore, inflammation and infection have a confounding effect on the commonly applied indicator and acute phase reactant, serum ferritin (SF). In the public health setting, a suitable method to assess iron status in developing countries has to be inexpensive, standardised, established, easy to measure and its applications specific to identifying ID. Aim We conducted secondary analysis of screening data from three independent iron intervention studies to critically evaluate the indicators used to determine iron status in 6-11-year-old primary school children from three South African provinces. Study design and methods A cross-sectional descriptive analysis was performed on the screening data collected in 2009 and 2010 during iron intervention studies in KwaZulu-Natal (n=736), Northern Cape (n= 1045), and North West (n=546). The three distinct study sites were analysed independently and collectively. Children’s haemoglobin (Hb), SF, transferrin receptor (TfR), zinc protoporphyrin (ZPP), and C-reactive protein (CRP) concentrations were measured and body iron calculated. ID prevalence was compared using different methods (namely the single indicators SF, TfR and ZPP, body iron and the multiple criteria model), and the influence of inflammation on SF was considered. Literature suggests that the multiple criteria model provides a more complete assessment of iron status. The performance of single and body iron indicators were compared to the multiple criteria model (by assessing sensitivity, specificity and predictive values). Results Significant positive correlations between CRP (indicator of inflammation) and SF existed in all study sites and the combined sample (p < 0.01). The mean SF concentration was substantially higher in subjects with inflammation than those without. A different SF cut-off to identify ID was applied to subjects with inflammation. The percentage of ID subjects varied using different indicators (4.2 – 26.5% in KwaZulu-Natal; 4.1 – 13.4% in Northern Cape; 7.0 – 24.4% in North West; and 5.4 – 15.2% in the combined sample). The sensitivity, specificity and predictive values of alternate ID indicators varied within and between study sites, compared to the multiple criteria model. Conclusion Simply using Hb as an ID indicator is inaccurate. The vast differences between percentages identified as ID by different indicators is reason for concern. No consistent agreement appeared between single ID indicators, body iron and the multiple criteria model for ID identification after correcting for inflammation in primary school children. The global view of the multiple criteria model as the gold standard for estimating ID is debatable and potentially impractical at a public health level. Current evidence cautions against overestimating the prevalence of ID, as there is more associated harm than deficiency underestimation. This critical analysis has confirmed a need for research to identify a suitable, accurate and precise alternative to Hb as a tool in the South African public health setting. Furthermore, the impact of inflammation on iron status indicators, in particular SF, should be assessed in context to clearly set parameters for its use in nationally-representative nutrition surveys, the cornerstone of iron intervention strategies. / MSc (Nutrition), North-West University, Potchefstroom Campus, 2015

Background The potential dire consequences of iron deficiency (ID) and iron deficiency anaemia (IDA) on childhood development are of major public health concern. Many factors contribute to anaemia, ID being only one progressive factor. The prevalence of ID and IDA must be accurately determined before iron intervention strategies can be safely prescribed. There is continued uncertainty regarding the optimal approach to identifying and measuring ID, as indicators have different roles, explore different aspects of iron metabolism and cannot be directly compared. Furthermore, inflammation and infection have a confounding effect on the commonly applied indicator and acute phase reactant, serum ferritin (SF). In the public health setting, a suitable method to assess iron status in developing countries has to be inexpensive, standardised, established, easy to measure and its applications specific to identifying ID. Aim We conducted secondary analysis of screening data from three independent iron intervention studies to critically evaluate the indicators used to determine iron status in 6-11-year-old primary school children from three South African provinces. Study design and methods A cross-sectional descriptive analysis was performed on the screening data collected in 2009 and 2010 during iron intervention studies in KwaZulu-Natal (n=736), Northern Cape (n= 1045), and North West (n=546). The three distinct study sites were analysed independently and collectively. Children’s haemoglobin (Hb), SF, transferrin receptor (TfR), zinc protoporphyrin (ZPP), and C-reactive protein (CRP) concentrations were measured and body iron calculated. ID prevalence was compared using different methods (namely the single indicators SF, TfR and ZPP, body iron and the multiple criteria model), and the influence of inflammation on SF was considered. Literature suggests that the multiple criteria model provides a more complete assessment of iron status. The performance of single and body iron indicators were compared to the multiple criteria model (by assessing sensitivity, specificity and predictive values). Results Significant positive correlations between CRP (indicator of inflammation) and SF existed in all study sites and the combined sample (p < 0.01). The mean SF concentration was substantially higher in subjects with inflammation than those without. A different SF cut-off to identify ID was applied to subjects with inflammation. The percentage of ID subjects varied using different indicators (4.2 – 26.5% in KwaZulu-Natal; 4.1 – 13.4% in Northern Cape; 7.0 – 24.4% in North West; and 5.4 – 15.2% in the combined sample). The sensitivity, specificity and predictive values of alternate ID indicators varied within and between study sites, compared to the multiple criteria model. Conclusion Simply using Hb as an ID indicator is inaccurate. The vast differences between percentages identified as ID by different indicators is reason for concern. No consistent agreement appeared between single ID indicators, body iron and the multiple criteria model for ID identification after correcting for inflammation in primary school children. The global view of the multiple criteria model as the gold standard for estimating ID is debatable and potentially impractical at a public health level. Current evidence cautions against overestimating the prevalence of ID, as there is more associated harm than deficiency underestimation. This critical analysis has confirmed a need for research to identify a suitable, accurate and precise alternative to Hb as a tool in the South African public health setting. Furthermore, the impact of inflammation on iron status indicators, in particular SF, should be assessed in context to clearly set parameters for its use in nationally-representative nutrition surveys, the cornerstone of iron intervention strategies. / MSc (Nutrition), North-West University, Potchefstroom Campus, 2015

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Made available in DSpace on 2014-12-17T14:16:23Z (GMT). No. of bitstreams: 1 ValdjaneS.pdf: 2387721 bytes, checksum: d21580a2388ac377d21ffb9abbbd4392 (MD5) Previous issue date: 2009-03-27 / Ferritin is a protein composed of heavy and light chains, non-covalently linked and which accommodates, in its core, thousands of atoms of iron. Furthermore, this protein represents the stock of iron in the body and it is characterized as an acute marker and predictor of diseases, such as iron deficiency anemia, hereditary hemochromatosis and others. Considering the variability of reference values and the analytical methods currently available, the aim of this work was to propose 95% confidence intervals for adults in the State of Rio Grande do Norte, Brazil, after determining the average concentration of serum ferritin for both sexes, beyond its correlation with the age. We analyzed 385 blood samples, collected by venipuncture from individuals residing in the State, after 12-14 hours of fast. The populational sample had 169 men and 216 women between 18-59 years old, which filled a questionnaire on socioeconomic, food habits and accounts about previous and current diseases. The sample collections were itinerant and the results of erythrogram, fasting glucose, alanine aminotransferase, aspartate aminotransferase, &#947;-glutamyl transferase, urea, creatinine, leukocyte count and platelets, beyond C-reactive protein, were issued to each participant, so that, after selection of the apparently healthy individuals, the dosage of serum ferritin was carried out. Statistical analysis was performed using the softwares SPSS 11.0 Windows version, Epi Info 3.3.2 and Graf instant pad (version 3.02), and the random population sample was single (finite population), for which the test of linear correlation and diagram of dispersion were also made. After selection of individuals and determination of serum ferritin, the most discrepant outliers were disregarded (N = 358, Men = 154/Women = 207) and the average value determined for the masculine sex individuals was 167,18 ng / dL; for the feminine sex individuals, the average value obtained was 81,55 ng / dL. Moreover, we found that 25% of men had values < 90,30 ng / dL; 50% &#8804; 156,25 ng / dL and 75% &#8804; 229,00 ng / dL. In the group of women, 25% had values < 38,80 ng / dL; 50% &#8804; 65,00 ng / dL and 75% &#8804; 119,00 ng / dL. Through the correlation coefficient (r = 0,23 with p = 0,003), it is possible to suggest the existence of positive linear correlation between age and serum ferritin for men. The correlation coefficient for women (r = 0,16 with p = 0,025) also confirms the existence of positive linear correlation between serum ferritin and age. Considering the analysis carried out and specific methods corroborating with the proposed benchmarks, we concluded that the average value found for men is higher than that found for women. Furthermore, this scenario rises with age for both sexes, and the 95% confidence intervals obtained were 74 ng/dL &#8804; &#956; &#8804; 89 ng/dL and 152ng/dL &#8804; &#956; &#8804;183ng/dL for the feminine and masculine sex individuals respectively / A ferritina ? uma prote?na composta por cadeias leves e pesadas ligadas n?o- covalentemente e que acomoda, em seu n?cleo, milhares de ?tomos de ferro. Al?m disso, esta prote?na representa os estoques de ferro no organismo e caracteriza-se como marcador de fase aguda e preditor de doen?as como anemia por defici?ncia de ferro, hemocromatose heredit?ria, entre outras. Diante da variabilidade de valores de refer?ncia e m?todos anal?ticos dispon?veis atualmente, a presente pesquisa objetivou propor intervalos de refer?ncia com 95% de confian?a para adultos do Estado do Rio Grande do Norte, ap?s determina??o da concentra??o m?dia de ferritina s?rica para ambos os sexos, correlacionando-as tamb?m com a idade. Foram analisadas 385 amostras de sangue, coletadas ap?s 12-14 horas de jejum por venopun??o, de indiv?duos residentes no Estado, sendo 169 homens e 216 mulheres entre 18-59 anos, os quais responderam a um question?rio relacionado a aspectos s?cio-econ?micos, alimentares, hist?rico de doen?as anteriores e queixas atuais. A coleta teve car?ter itinerante, tendo sido emitidos a cada participante os resultados de eritrograma, glicose em jejum, alanina aminotransferase, aspartato aminotransferase, &#947;- glutamil transferase, ureia, creatinina, contagem de leuc?citos e plaquetas, al?m de prote?na C reativa de modo que, ap?s sele??o dos indiv?duos aparentemente saud?veis, foi feita a dosagem de ferritina s?rica. As an?lises estat?sticas foram realizadas utilizando-se os softwares SPSS Windows vers?o 11.0, Epi Info 3.3.2 e Graf pad instant (vers?o 3.02), sendo que a amostra populacional foi aleat?ria simples (popula??o finita) para a qual foi feito o teste de correla??o linear e diagrama de dispers?o. Ap?s a sele??o dos indiv?duos e determina??o da ferritina s?rica, os outliers mais discrepantes foram desconsiderados, obtendo-se um valor m?dio para os indiv?duos do sexo masculino de 167,18 ng/dL e, para os indiv?duos do sexo feminino de 81,55 ng/dL. Analisando os valores obtidos, temos que 25% dos homens apresentaram valores < 90,30 ng/dL; 50% &#8804; 156,25 ng/dL e 75% &#8804; 229,00 ng/dL. No grupo das mulheres, 25% apresentam valores < 38,80 ng/dL; 50% &#8804; 65,00 ng/dL e 75% &#8804;119,00 ng/dL. Por meio do coeficiente de correla??o, r = 0,23, e p = 0,003, ? poss?vel confirmar a exist?ncia de correla??o linear positiva entre idade e ferritina s?rica dos indiv?duos do sexo masculino, assim como o coeficiente de correla??o r = 0,16 e p = 0,025 confirma a exist?ncia de correla??o linear positiva entre a ferritina s?rica e a idade das mulheres. Diante das an?lises realizadas e corroborando com m?todos espec?ficos para proposi??o de valores de refer?ncia, conclu?mos que o valor m?dio encontrado para homens ? superior ao valor m?dio encontrado para mulheres, elevando-se com a idade para os indiv?duos de ambos os sexos. Al?m disso, os intervalos de refer?ncia determinados com 95% de confian?a, foram de 74 ng/dL &#8804; &#956; &#8804; 89 ng/dL e de 152 ng/dL &#8804; &#956; &#8804; 183 ng/dL, para os indiv?duos dos sexos feminino e masculino, respectivamente

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