The Homozygous Hemoglobin EE Genotype and Chronic Inflammation Are Associated with High Serum Ferritin and Soluble Transferrin Receptor Concentrations among Women in Rural Cambodia.
BACKGROUND
Ferritin and soluble transferrin receptor (sTfR) concentrations are commonly used to assess iron deficiency (ID); however, they are influenced by multiple factors.


OBJECTIVE
We assessed associations between numerous variables and both ferritin and sTfR concentrations in Cambodian women and compared ID prevalence through the use of study-generated correction factors (CFs) for ferritin with those from a published meta-analysis.


METHODS
Venous blood from 450 women (aged 18-45 y) was assessed for hemoglobin (Hb), ferritin, sTfR, retinol binding protein, folate, vitamin B-12, C-reactive protein, α-1 acid glycoprotein (AGP), and genetic Hb disorders. Linear regression was used to calculate geometric mean ratios (95% CIs) for ferritin and sTfR concentrations.


RESULTS
The variant Hb EE genotype was associated with 50% (14%, 96%) and 51% (37%, 66%) higher geometric mean ferritin and sTfR concentrations, respectively, than was the normal Hb AA genotype; a 1-g/L increase in AGP was associated with 99% (50%, 162%) and 48% (33%, 64%) higher concentrations in the same variables, respectively. ID prevalence in nonpregnant women (n = 420) was 2% (n = 9) with the use of ferritin <15 μg/L and 18% (n = 79) with the use of sTfR >8.3 mg/L as criteria. ID prevalence with the use of sTfR was higher in women with the Hb EE genotype (n = 17; 55%) than in those with the Hb AA genotype (n = 20; 10%); and in women with the Hb AA genotype and chronic inflammation (n = 10; 18%) than in that group of women without chronic inflammation (n = 10; 7%) (P < 0.05). No differences in ID prevalence were found with the use of ferritin between women with Hb EE and AA genotypes (P = 1.0) or by chronic inflammation status (P = 0.32). There were no differences in mean ferritin concentrations among all 450 women when study-generated CFs were compared with those from the meta-analysis (P = 0.87).


CONCLUSIONS
Compared with sTfR, ferritin concentrations appear to reflect more accurately true ID in rural Cambodian women. The CFs from a published meta-analysis were appropriate for use in this population with a high prevalence of Hb disorders and inflammation.
Food, Nutrition and Health and The Child and Family Research Institute, Vancouver, Canada;
Crystal D
CD
Karakochuk
Food, Nutrition and Health and The Child and Family Research Institute, Vancouver, Canada;
Kyly C
KC
Whitfield
Food, Nutrition and Health and The Child and Family Research Institute, Vancouver, Canada;
Aviva I
AI
Rappaport
Food, Nutrition and Health and.
Susan I
SI
Barr
Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, Canada; The Child and Family Research Institute, Vancouver, Canada; Division of Hematopathology, Children and Women's Health Centre of British Columbia, Vancouver, Canada;
Suzanne M
SM
Vercauteren
Food, Nutrition and Health and.
Judy
J
McLean
National Maternal and Child Health Center, Ministry of Health, Phnom Penh, Cambodia;
Sophonneary
S
Prak
Helen Keller International, Cambodia Country Office, Phnom Penh, Cambodia; and.
Kroeun
K
Hou
Helen Keller International, Cambodia Country Office, Phnom Penh, Cambodia; and.
Aminuzzaman
A
Talukder
Laboratory Department, National Pediatric Hospital, Phnom Penh, Cambodia.
Robyn
R
Devenish
Food, Nutrition and Health and The Child and Family Research Institute, Vancouver, Canada; tim.green@ubc.ca.
Timothy J
TJ
Green
D000293:Adolescent; D000328:Adult; D002160:Cambodia; D002908:Chronic Disease; D005260:Female; D005293:Ferritins / Q000097:blood*; D005838:Genotype; D006441:Hemoglobin A / Q000235:genetics; D006446:Hemoglobin E / Q000235:genetics*; D006720:Homozygote; D006801:Humans; D007249:Inflammation / Q000097:blood*; D000090463:Iron Deficiencies; D008875:Middle Aged; D011247:Pregnancy; D011990:Receptors, Transferrin / Q000097:blood*; D012424:Rural Population; D055815:Young Adult
D011990:Receptors, Transferrin; C028672:hemoglobin AA; D005293:Ferritins; D006441:Hemoglobin A; D006446:Hemoglobin E
Cambodia; anemia; correction factor; ferritin; hemoglobin; inflammation; iron deficiency; soluble transferrin receptor; thalassemia; women