title: Serum transferrin receptor and zinc protoporphyrin as indicators of iron status in African children.
abstract: BACKGROUND
  Although transferrin receptor (TfR) and zinc protoporphyrin (ZnPP) are often used to define iron status in school-age children in developing countries, the diagnostic cutoffs for this age group are uncertain.
  
  
  OBJECTIVE
  The objective was to determine the sensitivity and specificity of TfR and ZnPP in predicting iron deficiency in black and white children in Africa.
  
  
  METHODS
  Hemoglobin, C-reactive protein (CRP), serum ferritin (SF), TfR, and ZnPP were measured in children in Côte d'Ivoire and Morocco. We excluded children with elevated CRP and then used receiver operating characteristic (ROC) curves to evaluate TfR and ZnPP alone and in combination in screening for iron deficiency, defined as an SF concentration <15 mug/L, and iron deficiency anemia (IDA), defined as an SF concentration <15 mug/L and low hemoglobin.
  
  
  RESULTS
  The sample included 2814 children aged 5-15 y. The sensitivity and specificity of TfR and ZnPP were limited by considerable overlap between iron-sufficient, nonanemic children and those with IDA. On the basis of ROC curves, we identified diagnostic cutoffs for TfR and ZnPP that achieved specificities and sensitivities of approximately 60-80%. Separate cutoffs for Côte d'Ivoire and Morocco gave the best performance; the cutoffs for both TfR and ZnPP were higher in Côte d'Ivoire. Moreover, a comparison of nonanemic, iron-sufficient subjects showed that Ivorian children had significantly higher TfR and ZnPP concentrations than did Moroccan children (P < 0.01).
  
  
  CONCLUSIONS
  New diagnostic cutoffs for TfR and ZnPP, based on ROC curve analyses, may improve the performance of these indexes in defining iron status in children. Significant ethnic differences in TfR and ZnPP suggest that separate cutoffs may be needed for black and white children.
authors.affiliation: Human Nutrition Laboratory, Swiss Federal Institute of Technology, Zürich, Switzerland. michael.zimmermann@ilw.agrl.ethz.ch
authors.forename: Michael B
authors.initials: MB
authors.lastname: Zimmermann
authors.forename: Luciano
authors.initials: L
authors.lastname: Molinari
authors.forename: Franziska
authors.initials: F
authors.lastname: Staubli-Asobayire
authors.forename: Sonja Y
authors.initials: SY
authors.lastname: Hess
authors.forename: Noureddine
authors.initials: N
authors.lastname: Chaouki
authors.forename: Pierre
authors.initials: P
authors.lastname: Adou
authors.forename: Richard F
authors.initials: RF
authors.lastname: Hurrell
mesh_terms: D000293:Adolescent; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000175:diagnosis; D015415:Biomarkers / Q000097:blood; D044383:Black People; D002648:Child; D002675:Child, Preschool; D007560:Cote d'Ivoire; D004909:Erythrocyte Indices; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D000090463:Iron Deficiencies; D008297:Male; D009018:Morocco; D011237:Predictive Value of Tests; D011524:Protoporphyrins / Q000097:blood*; D012372:ROC Curve; D011990:Receptors, Transferrin / Q000097:blood*; D012015:Reference Standards; D012680:Sensitivity and Specificity; D044465:White People
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D011524:Protoporphyrins; D011990:Receptors, Transferrin; C017803:zinc protoporphyrin