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Hua M, Shi D, Xu W, Zhu L, Hao X, Zhu B, Shu Q, Lozoff B, Geng F, Shao J. Differentiation between fetal and postnatal iron deficiency in altering brain substrates of cognitive control in pre-adolescence. BMC Med 2023; 21:167. [PMID: 37143078 PMCID: PMC10161450 DOI: 10.1186/s12916-023-02850-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/27/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Early iron deficiency (ID) is a common risk factor for poorer neurodevelopment, limiting children's potential and contributing to global burden. However, it is unclear how early ID alters the substrate of brain functions supporting high-order cognitive abilities and whether the timing of early ID matters in terms of long-term brain development. This study aimed to examine the effects of ID during fetal or early postnatal periods on brain activities supporting proactive and reactive cognitive control in pre-adolescent children. METHODS Participants were part of a longitudinal cohort enrolled at birth in southeastern China between December 2008 and November 2011. Between July 2019 and October 2021, 115 children aged 8-11 years were invited to participate in this neuroimaging study. Final analyses included 71 children: 20 with fetal ID, 24 with ID at 9 months (postnatal ID), and 27 iron-sufficient at birth and 9 months. Participants performed a computer-based behavioral task in a Magnetic Resonance Imaging scanner to measure proactive and reactive cognitive control. Outcome measures included accuracy, reaction times, and brain activity. Linear mixed modeling and the 3dlme command in Analysis of Functional NeuroImages (AFNI) were separately used to analyze behavioral performance and neuroimaging data. RESULTS Faster responses in proactive vs. reactive conditions indicated that all groups could use proactive or reactive cognitive control according to contextual demands. However, the fetal ID group was lower in general accuracy than the other 2 groups. Per the demands of cues and targets, the iron-sufficient group showed greater activation of wide brain regions in proactive vs. reactive conditions. In contrast, such condition differences were reversed in the postnatal ID group. Condition differences in brain activation, shown in postnatal ID and iron-sufficient groups, were not found in the fetal ID group. This group specifically showed greater activation of brain regions in the reward pathway in proactive vs. reactive conditions. CONCLUSIONS Early ID was associated with altered brain functions supporting proactive and reactive cognitive control in childhood. Alterations differed between fetal and postnatal ID groups. The findings imply that iron supplement alone is insufficient to prevent persisting brain alterations associated with early ID. Intervention strategies in addition to the iron supplement should consider ID timing.
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Affiliation(s)
- Mengdi Hua
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Donglin Shi
- Department of Curriculum and Learning Sciences, Zhejiang University, Hangzhou, China
| | - Wenwen Xu
- Department of Curriculum and Learning Sciences, Zhejiang University, Hangzhou, China
| | - Liuyan Zhu
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoxin Hao
- Department of Curriculum and Learning Sciences, Zhejiang University, Hangzhou, China
| | - Bingquan Zhu
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiang Shu
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- National Clinical Research Center for Child Health, Hangzhou, China
| | - Betsy Lozoff
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Fengji Geng
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
- Department of Curriculum and Learning Sciences, Zhejiang University, Hangzhou, China.
- National Clinical Research Center for Child Health, Hangzhou, China.
| | - Jie Shao
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
- National Clinical Research Center for Child Health, Hangzhou, China.
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Geng F, Mai X, Zhan J, Xu L, Georgieff M, Shao J, Lozoff B. Timing of iron deficiency and recognition memory in infancy. Nutr Neurosci 2022; 25:1-10. [PMID: 31906824 PMCID: PMC7338245 DOI: 10.1080/1028415x.2019.1704991] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective: To determine the relationship between iron deficiency (or iron-deficient, ID) and neural correlates of recognition memory depending on ID timing (gestation vs. infancy) and infant age at testing (9 vs. 18 months).Study design: Event-related potentials (ERP) were used in a visual recognition memory task (mother vs. stranger face) to compare healthy term infants according to iron status at birth and 9 months. Fetal-neonatal ID was defined as cord serum ferritin < 75 µg/l or zinc protoporphrin/heme ratio > 118 µmol/mol, postnatal ID as ≥ 2 abnormal iron measures at 9 months with normal cord-blood iron status, and iron-sufficient as not ID at birth or 9 months. Recognition of mother faces was measured by negative component (Nc) and late slow wave (LSW). These ERP components reflect attention and memory updating processes, respectively.Results: All groups showed differences in Nc amplitude elicited by mother and stranger faces at 9 months. At 18 months, only postnatal ID and iron-sufficient groups showed condition differences in Nc amplitude. However, the 2 groups were different in the involved brain regions. For LSW, only the 2 ID groups showed condition differences in amplitude at 9 months. At 18 months, condition differences were not observed in any group.Conclusions: This study indicates that the timing of ID in early life (fetal-neonatal vs. postnatal) modulates the impact of ID on recognition memory. Such impact also varies depending on the age of infants at testing (9 vs. 18 months).
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Affiliation(s)
- Fengji Geng
- Department of Curriculum and Learning Sciences, Zhejiang University, Hangzhou, People’s Republic of China
| | - Xiaoqin Mai
- Department of Psychology, Renmin University of China, Beijing, People’s Republic of China
| | - Jianying Zhan
- Children’s Hospital Zhejiang University School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Lin Xu
- Children’s Hospital Zhejiang University School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Michael Georgieff
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Jie Shao
- Children’s Hospital Zhejiang University School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Betsy Lozoff
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA,Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
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Tchum SK, Arthur FK, Adu B, Sakyi SA, Abubakar LA, Atibilla D, Amenga-Etego S, Oppong FB, Dzabeng F, Amoani B, Gyan T, Arhin E, Poku-Asante K. Impact of iron fortification on anaemia and iron deficiency among pre-school children living in Rural Ghana. PLoS One 2021; 16:e0246362. [PMID: 33571267 PMCID: PMC7877575 DOI: 10.1371/journal.pone.0246362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 01/18/2021] [Indexed: 02/06/2023] Open
Abstract
Anaemia in young sub-Saharan African children may be due to the double burden of malaria and iron deficiency. Primary analysis of a double-blind, cluster randomized trial of iron containing micronutrient powder supplementation in Ghanaian children aged 6 to 35 months found no difference in malaria risk between intervention and placebo groups. Here, we performed a secondary analysis of the trial data to assess the impact of long-term prophylactic iron fortificant on the risk of iron deficiency and anaemia in trial subjects. This population-based randomized-cluster trial involved 1958 children aged between 6 to 35 months, identified at home and able to eat semi-solid foods. The intervention group (n = 967) received a daily dose containing 12.5 mg elemental iron (as ferrous fumarate), vitamin A (400 μg), ascorbic acid (30 mg) and zinc (5 mg). The placebo group (n = 991) received a similar micronutrient powder but without iron. Micronutrient powder was provided daily to both groups for 5 months. At baseline and endline, health assessment questionnaires were administered and blood samples collected for analysis. The two groups had similar baseline anthropometry, anaemia, iron status, demographic characteristics, and dietary intakes (p > 0.05). Of the 1904 (97.2%) children who remained at the end of the intervention, the intervention group had significantly higher haemoglobin (p = 0.0001) and serum ferritin (p = 0.0002) levels than the placebo group. Soluble transferrin receptor levels were more saturated among children from the iron group compared to non-iron group (p = 0.012). Anaemia status in the iron group improved compared to the placebo group (p = 0.03). Continued long-term routine use of micronutrient powder containing prophylactic iron reduced anaemia, iron deficiency and iron deficiency anaemia among pre-school children living in rural Ghana's malaria endemic area.
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Affiliation(s)
- Samuel Kofi Tchum
- Department of Biochemistry and Biotechnology, College of Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Kintampo Health Research Centre, Ghana Health Service, Kintampo-North, Ghana
- * E-mail:
| | - Fareed Kow Arthur
- Department of Biochemistry and Biotechnology, College of Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bright Adu
- Department of Immunology, College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Samuel Asamoah Sakyi
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Dorcas Atibilla
- Kintampo Health Research Centre, Ghana Health Service, Kintampo-North, Ghana
| | - Seeba Amenga-Etego
- Kintampo Health Research Centre, Ghana Health Service, Kintampo-North, Ghana
| | - Felix Boakye Oppong
- Kintampo Health Research Centre, Ghana Health Service, Kintampo-North, Ghana
| | - Francis Dzabeng
- Kintampo Health Research Centre, Ghana Health Service, Kintampo-North, Ghana
| | - Benjamin Amoani
- Department of Biomedical Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Thomas Gyan
- Kintampo Health Research Centre, Ghana Health Service, Kintampo-North, Ghana
| | - Emmanuel Arhin
- Faculty of Earth and Environmental Sciences, Department of Earth Science, C K. Tedam University of Technology and Applied Sciences, Navrongo, Ghana
| | - Kwaku Poku-Asante
- Kintampo Health Research Centre, Ghana Health Service, Kintampo-North, Ghana
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Shao J, Richards B, Kaciroti N, Zhu B, Clark KM, Lozoff B. Contribution of iron status at birth to infant iron status at 9 months: data from a prospective maternal-infant birth cohort in China. Eur J Clin Nutr 2020; 75:364-372. [PMID: 32814856 PMCID: PMC7878278 DOI: 10.1038/s41430-020-00705-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/22/2020] [Accepted: 08/04/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND/OBJECTIVES The contribution of iron status at birth to iron status in infancy is not known. We used a physiologic framework to evaluate how iron status at birth related to iron status at 9 months, taking iron needs and sources into account. SUBJECTS/METHODS In a longitudinal birth cohort in China, iron status measures in cord blood and venous blood in infancy (9 months) and clinical data were prospectively collected in 545 healthy term maternal–infant dyads. We used structural equation modeling (SEM) to create a 9-month iron composite and to assess direct and indirect contributions of multiple influences on 9-month iron status. Logistic regression was used to calculate odds ratios (OR) for iron deficiency (ID), iron deficiency anemia (IDA), and anemia. RESULTS Approximately 15% (78/523) of infants were born with cord SF<75 μg/l, suggesting fetal-neonatal ID. At 9 months, 34.8% (186/535) and 19.6% (105/535) of infants had ID and IDA, respectively. The following factors were independently associated with poorer 9-month iron status: higher cord zinc protoporphyrin/heme (ZPP/H) (adjusted estimate −0.18, P< 0.001) and serum transferrin receptor (sTfR) (−0.11, P=0.004), lower cord hemoglobin (Hb) (0.13, P=0.004), lower birth weight (0.15, P< 0.001), male sex (0.10, P=0.013), older age at testing (−0.26, P<0.001), higher 9-month weight (−0.12, P=0.006) and breastfeeding (0.38, P<0.001). Breastfeeding at 9 months showed the strongest association, adjusting for all other factors. Compared to formula-fed infants, the odds of IDA were 19.1 (95%CI: 6.92, 52.49, P< 0.001) and 3.6 (95%CI: 1.04, 12.50, P=0.043) times higher in breastfed and mixed-fed infants, respectively. CONCLUSIONS Indicators of iron status at birth, postnatal iron needs, and iron sources independently related to iron status at 9 months. Sex was an additional factor. Public health policies to identify and protect infants at increased risk of ID should be prioritized.
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Affiliation(s)
- Jie Shao
- Children's Hospital Zhejiang University School of Medicine, Hangzhou, 310052, China. .,National Clinical Research Center for Child Health, Hangzhou, 310052, China.
| | - Blair Richards
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
| | - Niko Kaciroti
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
| | - Bingquan Zhu
- Children's Hospital Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Katy M Clark
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
| | - Betsy Lozoff
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA.,Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
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Holmes DT, Buhr KA. Widespread Incorrect Implementation of the Hoffmann Method, the Correct Approach, and Modern Alternatives. Am J Clin Pathol 2019; 151:328-336. [PMID: 30475946 DOI: 10.1093/ajcp/aqy149] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objectives The Hoffmann method is a procedure for reference interval estimation using routine clinical results. Many authors incorrectly prepare Hoffmann plots on a linear rather than normal probability scale. We explore the consequences. Methods This was investigated algebraically, by random number simulations (45 simulations, n = 100,000 each) and using clinical data sets. Strategies compared were: Hoffmann's method as originally and incorrectly implemented, Bhattacharya's method, and maximum likelihood (ML). All R source code and data sets are provided. Results As the proportion of healthy individuals approaches 1, the incorrect approach generates reference interval estimates of approximately μH ± 1.19 σH delineating the central 77% of the healthy subpopulation, not the central 95%. Inappropriately narrow reference interval estimates were seen on random simulations and clinical data sets. ML methods performed best. Conclusions The erroneous variant Hoffmann method should not be used. ML methods outperform others and are not restricted by Gaussian assumptions.
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Affiliation(s)
- Daniel T Holmes
- Department of Pathology and Laboratory Medicine, St Paul’s Hospital, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Kevin A Buhr
- Biostatistics and Medical Informatics, University of Wisconsin, Madison
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Kanuri G, Chichula D, Sawhney R, Kuriakose K, De'Souza S, Pais F, Arumugam K, Shet AS. Optimizing diagnostic biomarkers of iron deficiency anemia in community-dwelling Indian women and preschool children. Haematologica 2018; 103:1991-1996. [PMID: 30093400 PMCID: PMC6269316 DOI: 10.3324/haematol.2018.193243] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/06/2018] [Indexed: 12/31/2022] Open
Abstract
The detection of iron deficiency anemia is challenged by the paucity of diagnostic tests demonstrating high sensitivity and specificity. Using two biomarkers, zinc-protoporphyrin/heme and hepcidin, we established the diagnostic cut-off values for iron deficiency anemia in preschool children and women. We randomly selected non-anemic individuals (n=190; women=90, children=100) and individuals with iron deficiency anemia (n=200; women=100, children=100) from a preexisting cohort of healthy preschool children and their mothers. The diagnostic performance of these biomarkers was estimated by analyzing receiver operating characteristic curves. Diagnostic cut-offs with a high predictive value for iron deficiency anemia were selected. Median zinc-protoporphyrin/heme and hepcidin values in non-anemic children were 49 μmol/mol heme and 42 ng/mL, respectively, and in non-anemic women these values were 66 μmol/mol heme and 17.7ng/mL, respectively. Children and women with iron deficiency anemia had higher zinc-protoporphyrin/heme ratios (children=151 μmol/mol heme and women=155 μmol/mol heme) and lower hepcidin levels (children=1.2ng/mL and women=0.6ng/mL). A zinc-protoporphyrin/heme ratio cut-off >90 μmole/mole heme in children and >107 μmole/mole heme in women was associated with a high diagnostic likelihood for iron deficiency anemia (children, likelihood ratio=20.2: women, likelihood ratio=10.8). Hepcidin cut-off values of ≤6.8ng/mL in children and ≤4.5ng/mL in women were associated with a high diagnostic likelihood for iron deficiency anemia (children, likelihood ratio=14.3: women, likelihood ratio=16.2). The reference ranges and cut-off values identified in this study provide clinicians with guidance for applying these tests to detect iron deficiency anemia. Erythrocyte zinc-protoporphyrin/heme ratio is a valid point-of-care biomarker to diagnose iron deficiency anemia.
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Affiliation(s)
- Giridhar Kanuri
- Wellcome Trust-DBT Hematology Research Unit, St. Johns Research Institute, Bangalore, Karnataka, India.,Department of Biotechnology, KLEF, Greenfields, Vaddeswaram, Andhra Pradesh, India
| | - Deepti Chichula
- Wellcome Trust-DBT Hematology Research Unit, St. Johns Research Institute, Bangalore, Karnataka, India
| | - Ritica Sawhney
- Wellcome Trust-DBT Hematology Research Unit, St. Johns Research Institute, Bangalore, Karnataka, India
| | - Kevin Kuriakose
- Wellcome Trust-DBT Hematology Research Unit, St. Johns Research Institute, Bangalore, Karnataka, India
| | - Sherwin De'Souza
- Wellcome Trust-DBT Hematology Research Unit, St. Johns Research Institute, Bangalore, Karnataka, India
| | - Faye Pais
- Wellcome Trust-DBT Hematology Research Unit, St. Johns Research Institute, Bangalore, Karnataka, India
| | - Karthika Arumugam
- Wellcome Trust-DBT Hematology Research Unit, St. Johns Research Institute, Bangalore, Karnataka, India
| | - Arun S Shet
- Wellcome Trust-DBT Hematology Research Unit, St. Johns Research Institute, Bangalore, Karnataka, India .,National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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Lozoff B, Jiang Y, Li X, Zhou M, Richards B, Xu G, Clark KM, Liang F, Kaciroti N, Zhao G, Santos DC, Zhang Z, Tardif T, Li M. Low-Dose Iron Supplementation in Infancy Modestly Increases Infant Iron Status at 9 Mo without Decreasing Growth or Increasing Illness in a Randomized Clinical Trial in Rural China. J Nutr 2016; 146:612-21. [PMID: 26791556 PMCID: PMC4763485 DOI: 10.3945/jn.115.223917] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 10/10/2015] [Accepted: 12/09/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Previous trials of iron supplementation in infancy did not consider maternal iron supplementation. OBJECTIVE This study assessed effects of iron supplementation in infancy and/or pregnancy on infant iron status, illnesses, and growth at 9 mo. METHODS Enrollment occurred from December 2009 to June 2012 in Hebei, China. Infants born to women in a pregnancy iron supplementation trial were randomly assigned 1:1 to iron [∼1 mg Fe/(kg · d) as oral iron proteinsuccynilate] or placebo from 6 wk to 9 mo, excluding infants with cord ferritin <35 μg/L. Study groups were pregnancy placebo/infancy placebo (placebo/placebo), pregnancy placebo/infancy iron (placebo/iron), pregnancy iron/infancy placebo (iron/placebo), and pregnancy iron/infancy iron (iron/iron). The primary outcome was 9-mo iron status: iron deficiency (ID) by cutoff (≥2 abnormal iron measures) or body iron <0 mg/kg and ID + anemia (hemoglobin <110 g/L). Secondary outcomes were doctor visits or hospitalizations and weight or length gain from birth to 9 mo. Statistical analysis by intention to treat and dose-response (between number of iron bottles received and outcome) used logistic regression with concomitant RRs and general linear models, with covariate control as applicable. RESULTS Of 1482 infants randomly allocated, 1276 had 9-mo data (n = 312-327/group). Iron supplementation in infancy, but not pregnancy, reduced ID risk: RRs (95% CIs) were 0.89 (0.79, 0.998) for placebo/iron compared to placebo/placebo, 0.79 (0.63, 0.98) for placebo/iron compared to iron/placebo, 0.87 (0.77, 0.98) for iron/iron compared to placebo/placebo, and 0.86 (0.77, 0.97) for iron/iron compared to iron/placebo. However, >60% of infants still had ID at 9 mo. Receiving more bottles of iron in infancy was associated with better infant iron status at 9 mo but only among iron-supplemented infants whose mothers were also iron supplemented (i.e., the iron/iron group). There were no group differences in hospitalizations or illnesses and no adverse effects on growth overall or among infants who were iron sufficient at birth. CONCLUSIONS Iron supplementation in Chinese infants reduced ID at 9 mo without adverse effects on growth or illness. Effects of iron supplementation in pregnancy were observed only when higher amounts of iron were distributed in infancy. This trial was registered at clinicaltrials.gov as NCT00613717.
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Affiliation(s)
- Betsy Lozoff
- Center for Human Growth and Development and Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI;
| | | | - Xing Li
- Department of Pediatrics, and
| | - Min Zhou
- Women's and Children's Health Center, Peking University First Hospital, Beijing, China; and
| | | | | | | | | | | | - Gengli Zhao
- Women's and Children's Health Center, Peking University First Hospital, Beijing, China; and
| | - Denise Cc Santos
- Human Movement Sciences Graduate Program, Methodist University of Piracicaba, Piracicaba, Brazil
| | | | | | - Ming Li
- Department of Pediatrics, and
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8
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Armony-Sivan R, Zhu B, Clark KM, Richards B, Ji C, Kaciroti N, Shao J, Lozoff B. Iron deficiency (ID) at both birth and 9 months predicts right frontal EEG asymmetry in infancy. Dev Psychobiol 2015; 58:462-70. [PMID: 26668100 DOI: 10.1002/dev.21388] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 11/23/2015] [Indexed: 11/09/2022]
Abstract
This study considered effects of timing and duration of iron deficiency (ID) on frontal EEG asymmetry in infancy. In healthy term Chinese infants, EEG was recorded at 9 months in three experimental conditions: baseline, peek-a-boo, and stranger approach. Eighty infants provided data for all conditions. Prenatal ID was defined as low cord ferritin or high ZPP/H. Postnatal ID was defined as ≥ two abnormal iron measures at 9 months. Study groups were pre- and postnatal ID, prenatal ID only, postnatal ID only, and not ID. GLM repeated measure analysis showed a main effect for iron group. The pre- and postnatal ID group had negative asymmetry scores, reflecting right frontal EEG asymmetry (mean ± SE: -.18 ± .07) versus prenatal ID only (.00 ± .04), postnatal ID only (.03 ± .04), and not ID (.02 ± .04). Thus, ID at both birth and 9 months was associated with right frontal EEG asymmetry, a neural correlate of behavioral withdrawal and negative emotions.
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Affiliation(s)
- Rinat Armony-Sivan
- Department of Psychology, Ashkelon Academic College, Ashkelon, Israel.,Center for Human Growth and Development, University of Michigan, 300 N. Ingalls, 10th Floor, Ann Arbor, MI, 48109-5406
| | - Bingquan Zhu
- Department of Child Health Care, Children's Hospital of Zhejiang University, Hangzhou, China
| | - Katy M Clark
- Center for Human Growth and Development, University of Michigan, 300 N. Ingalls, 10th Floor, Ann Arbor, MI, 48109-5406
| | - Blair Richards
- Center for Human Growth and Development, University of Michigan, 300 N. Ingalls, 10th Floor, Ann Arbor, MI, 48109-5406
| | - Chai Ji
- Department of Child Health Care, Children's Hospital of Zhejiang University, Hangzhou, China
| | - Niko Kaciroti
- Center for Human Growth and Development, University of Michigan, 300 N. Ingalls, 10th Floor, Ann Arbor, MI, 48109-5406
| | - Jie Shao
- Department of Child Health Care, Children's Hospital of Zhejiang University, Hangzhou, China
| | - Betsy Lozoff
- Center for Human Growth and Development, University of Michigan, 300 N. Ingalls, 10th Floor, Ann Arbor, MI, 48109-5406. .,Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI.
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9
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Hinchliffe RF, Bellamy GJ, Bell F, Finn A, Vora AJ, Lennard L. Reference intervals for red cell variables and platelet counts in infants at 2, 5 and 13 months of age: a cohort study. J Clin Pathol 2013; 66:962-6. [PMID: 23853313 DOI: 10.1136/jclinpath-2013-201742] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To derive reference values for red cell variables and platelet counts from a cohort of infants sampled at precise ages during the first 13 months of life. METHODS Blood counts, reticulocyte counts and zinc protoporphyrin concentrations were obtained from healthy term infants of North European ancestry at 2, 5 and 13 months of age. RESULTS Mean cell volume (MCV) and mean cell haemoglobin (MCH) values did not differ significantly between 5 and 13 months and MCH concentration was unaffected by age. Values of all other variables at any one age differed significantly from those at the other two. Haemoglobin, mean cell haemoglobin, zinc protoporphyrin and platelet values (95% ranges) at 2 (n=119), 5 (n=97) and 13 months (n=42) were, respectively, 91-125, 101-129 and 105-133 g/L; 28.6-33.1, 24.5-28.7 and 24.3-28.7 pg; 36-116, 25-91 and 27-57 micromol/mol haem; and 216-658, 241-591 and 209-455×10(9)/L. At 2 and 5 months, respectively, 26.9% and 10.8% of subjects had platelet counts >500×10(9)/L. Reticulocyte counts at 2 months and MCV and MCH values at 5 months were significantly higher in girls. In boys, red cell distribution width values were significantly higher at 5 months, and zinc protoporphyrin values at both 2 and 5 months. CONCLUSIONS These findings indicate the value of obtaining reference data at precise ages during infancy and confirm and extend earlier reports indicating a gender difference in laboratory measures used to assess iron status in early infancy.
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Affiliation(s)
- R F Hinchliffe
- Department of Paediatric Haematology, Sheffield Children's NHS Foundation Trust, , Sheffield, UK
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10
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Yu KH. Effectiveness of zinc protoporphyrin/heme ratio for screening iron deficiency in preschool-aged children. Nutr Res Pract 2011; 5:40-5. [PMID: 21487495 PMCID: PMC3061269 DOI: 10.4162/nrp.2011.5.1.40] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 02/01/2011] [Accepted: 02/01/2011] [Indexed: 11/21/2022] Open
Abstract
Hemoglobin and zinc protoporphyrin (ZPP) tests are commonly used to screen for iron deficiency, but little research has been done to systematically evaluate the sensitivity and specificity of these two tests. The goal of this study was to evaluate the effectiveness of zinc protoporphyrin/heme (ZPP/H) ratio as a point-of-service screening test for iron deficiency among preschool-aged children by comparing the sensitivity and specificity of hemoglobin, ZPP/H ratio, and serum ferritin (SF). Also completed were assessments for the prevalence of anemia, iron deficiency (ID), and iron deficiency anemia (IDA) with indicators of ferritin models. This study was carried out with 95 children ages 3 to 6 y. Anthropometric measurements were assessed, and blood samples were analyzed for hemoglobin, SF, transferrin saturation (TS), and ZPP. Anemia was common and the prevalences of anemia, ID, and IDA were 14.7%, 12.6%, and 5.2%, respectively. The ZPP/H ratio was strongly and significantly correlated with hemoglobin. And ZPP/H ratio was a more sensitive test for ID than hemoglobin or SF measurement, correctly identifying more than twice as many iron-deficient children (sensitivity of 91.7%, compared to 41.7% for hemoglobin and SF). However, ZPP/H ratio had lower specificity (60.2%, compared to 89.1% for hemoglobin or 96.4% for SF) and resulted in the false identification of more subjects who actually were not iron deficient than did hemoglobin or SF. Low hemoglobin concentration is a late-stage indicator of ID, but ZPP/H ratio can detect ID at early stages and can be performed easily at a relatively low cost. Therefore, ZPP/H ratio can serve as a potential screening test for pre-anemic iron deficiency in community pediatric practices.
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Affiliation(s)
- Kyeong Hee Yu
- Department of Hotel Culinary Arts, Ulsan College, 101 Bongsu-ro, Dong-gu, Ulsan 682-715, Korea
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Assessment of environmental distribution of lead in some municipalities of South-Eastern Nigeria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2010; 7:2501-13. [PMID: 20644686 PMCID: PMC2905563 DOI: 10.3390/ijerph7062501] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 06/01/2010] [Accepted: 06/07/2010] [Indexed: 11/17/2022]
Abstract
Lead (Pb) levels were measured in roadside surface soils, dust particles and rain water samples from the urban cities of Enugu, Awka, Onitsha, Nnewi, Aba, Port Harcourt and Warri in Southern Nigeria in 2007 and 2008. Samples were collected during the dry season, while rain water samples were collected during the early rain (April–June), mid rain (July–August) and late rain seasons (September–October) for the two years. Soil samples were collected from traffic congested roads, dust was collected by tying a plastic basin on a pole 1.5 m above ground level and leaving it for 45 days. Rain samples were collected from three equidistant points. Samples were analyzed by AAS. The highest soil Pb of 120.00 ± 0.00 and 80.36 ± 0.00 mg/kg were reported in Onitsha for 2007 and 2008, respectively. Nnewi showed 33.40 ± 0.01 and 4,238.29 ± 0.00 mg/kg for 2007 and 2008. Aba had 22.56 ± 0.01 and 21.28 ± 0.00 mg/kg for 2007 and 2008. Higher concentrations were recorded for Nnewi and Port Harcourt in 2008 than in 2007. Enugu had more in 2007 while Awka had more in 2008. Dust Pb ranged from 0.13–0.49 mg/kg and 0.15–0.47 mg/kg for 2007 and 2008, respectively. Rain samples had the least Pb concentration, ranging from 0.103 ± 0.000 to 0.163 ± 0.046 mg/L. We may conclude that Nigerians are exposed to environmental Pb.
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Lead poisoning associated with malaria in children of urban areas of Nigeria. Int J Hyg Environ Health 2008; 211:591-605. [PMID: 18599348 DOI: 10.1016/j.ijheh.2008.05.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Revised: 05/06/2008] [Accepted: 05/07/2008] [Indexed: 12/24/2022]
Abstract
The principal objectives of this study are to (a) investigate the prevalence of elevated blood lead levels (EBLLs) in children of three major cities of Nigeria with different levels of industrial pollution; (b) identify the environmental, social and behavioral risk factors for the EBLLs in the children; and (c) explore the association between malaria (endemic in the study areas) and EBLLs in the pediatric population. The study involved 653 children aged 2-9 years (average, 3.7 years). The mean blood lead level (BLL) for the children was 8.9+/-4.8microg/dL, the median value was 7.8microg/dL, and the range was 1-52microg/dL. About 25% of the children had BLL greater than 10microg/dL. There were important differences in BLLs across the three cities, with the average value in Ibadan (9.9+/-5.2microg/dL) and Nnewi (8.3+/-3.5microg/dL) being higher than that in Port Harcourt (4.7+/-2.2micro/dL). Significant positive associations were found between BLL and a child's town of residence (p<0.001), age of the child (p=0.004), length of time the child played outside (p<0.001), presence of pets in a child's home (p=0.023), but negatively with educational level of caregiver (p<0.001). This study is one of the first to find a significant negative association between BLL and malaria in a pediatric population, and this association remained significant after controlling for confounding diseases and symptoms. The shared environmental and socio-demographic risks factors for lead exposure and Plasmodium (most common malaria parasites) infection in urban areas of Nigeria are discussed along with possible ways that lead exposure may influence the host response to infection with malarial parasites.
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Soldin OP, Dahlin JRB, Gresham EG, King J, Soldin SJ. IMMULITE 2000 age and sex-specific reference intervals for alpha fetoprotein, homocysteine, insulin, insulin-like growth factor-1, insulin-like growth factor binding protein-3, C-peptide, immunoglobulin E and intact parathyroid hormone. Clin Biochem 2008; 41:937-42. [PMID: 18503765 DOI: 10.1016/j.clinbiochem.2008.04.025] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2008] [Revised: 04/22/2008] [Accepted: 04/22/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine age and sex-specific pediatric reference intervals for serum alpha fetoprotein, homocysteine, insulin, insulin-like growth factor-I, insulin-like growth factor binding protein-3, C-peptide, immunoglobulin E and parathyroid hormone. DESIGN AND METHODS The study was conducted at both Children's National Medical Center and Georgetown University, Washington D.C. Results for the above analytes were obtained from the Children's National Medical Center laboratory information system over the period of 1/5/2001-3/8/2007. Patient results using the IMMULITE 2000(R) were accessed and used to establish reference intervals for the analytes studied. All patient identifiers were removed except age and sex. Analysis of the data was performed at Georgetown University in the Bioanalytical Core Laboratory. The data was analyzed using the Hoffmann approach, and was computer adapted. The number of patient samples studied varied with each analyte and were: Alpha fetoprotein (557), homocysteine (924), insulin-like growth factor-1 (1352), insulin-like growth factor binding protein-3 (711), insulin (3239), C-peptide (267), immunoglobulin E (2691) and parathyroid hormone (513). RESULTS AND CONCLUSIONS This study provides pediatric reference intervals for the eight analytes for children from birth to 18 years of age. All the analytes exhibited at least some age dependence. Sex differences between early and late childhood and adolescence were also frequently found.
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Affiliation(s)
- Offie P Soldin
- Department of Oncology, Physiology, Georgetown University Medical Center, USA
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Choi J, Tanaka T, Koren G, Ito S. Lead exposure during breastfeeding. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2008; 54:515-516. [PMID: 18411377 PMCID: PMC2294082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
QUESTION Owing to the recent concerns of lead (Pb) leaking into tap water, one of our female patients is concerned about the effects of Pb exposure to newborns while breastfeeding. How should I advise her and should she switch to formula feeding? ANSWER Lead exposure through drinking tap water while breastfeeding is not associated with any serious concerns in most available studies. There is currently no safe level of Pb exposure, but environmental exposure within Canada is low. At present, Pb levels in drinking water are carefully monitored by Health Canada and are not likely to be of concern to breastfeeding mothers. Switching to formula feeding is not necessary and not recommended, as improperly prepared formula can have higher Pb levels.
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van Rheenen PF, de Moor LTT, Eschbach S, Brabin BJ. A cohort study of haemoglobin and zinc protoporphyrin levels in term Zambian infants: effects of iron stores at birth, complementary food and placental malaria. Eur J Clin Nutr 2007; 62:1379-87. [PMID: 17671442 DOI: 10.1038/sj.ejcn.1602862] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine zinc-protoporphyrin (ZPP) and haemoglobin levels, and to determine predictors of iron deficiency anaemia (IDA) in Zambian infants. SUBJECTS AND METHODS Ninety-one women and their normal birth weight (NBW) infants were followed bi-monthly during the first 6 months of life, and iron status, food intake, malaria parasitaemia and growth were monitored. At 4 months, the infants were divided into two groups, and the data were analysed according to whether or not they were exclusively breastfed. RESULTS Almost two-third of infants were born with low iron stores as defined by ZPP levels, and this proportion increased with age. Over 50% had developed IDA by 6 months. Exclusive breastfeeding at 4 months could be a protective factor for IDA (odds ratio (OR): 0.2; 95% confidence interval (CI): 0.0-1.1). Exclusively breastfed infants had higher haemoglobin values at 4 and 6 months (mean difference 0.6; 95% CI: 0.1-1.2 g/dl and mean difference 0.9; 95% CI: 0.2-1.7 g/dl, respectively), compared with infants with early complementary feeding. In univariate analysis, past or chronic placental malaria appeared to be a predictor of IDA at 4 and 6 months, but the significance was lost in multivariate analysis. CONCLUSIONS Zambian NBW infants are born with low iron stores and have a high risk to develop IDA in the first 6 months of life. Continuation of exclusive breastfeeding after 4 months is associated with a reduction of anaemia. The effect of placental malaria infection on increased risk of infant IDA could not be proven.
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Affiliation(s)
- P F van Rheenen
- Paediatric Gastroenterology, Department of Paediatrics, University Medical Centre, Groningen, The Netherlands.
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van Rheenen P, de Moor L, Eschbach S, de Grooth H, Brabin B. Delayed cord clamping and haemoglobin levels in infancy: a randomised controlled trial in term babies. Trop Med Int Health 2007; 12:603-16. [PMID: 17445128 DOI: 10.1111/j.1365-3156.2007.01835.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES This study was carried out to assess whether delaying umbilical cord clamping is effective in improving the haematological status of term infants living in a malaria-endemic area, and whether this is associated with complications in infants and mothers. METHODS We randomly assigned women delivering term babies in Mpongwe Mission Hospital, Zambia, to delayed cord clamping (DCC, n = 46) or immediate cord clamping (controls, n = 45) and followed their infants on a bi-monthly basis until the age of 6 months. We compared the haemoglobin (Hb) change from cord values and the proportion of anaemic infants. Secondary outcomes related to infant and maternal safety. RESULTS Throughout the observation period infant Hb levels in both groups declined, but more rapidly in controls than in the DCC group [difference in Hb change from baseline at 4 months 1.1 g/dl, 95% confidence interval (CI) 0.2; 2.1]. By 6 months, this difference had disappeared (0.0 g/dl, 95% CI -0.9; 0.8). The odds ratio for iron deficiency anaemia in the DCC group at 4 months was 0.3 (95% CI 0.1; 1.0), but no differences were found between the groups at 6 months. No adverse events were seen in infants and mothers. CONCLUSION Our findings indicate that DCC could help improve the haematological status of term infants living in a malaria-endemic region at 4 months of age. However, the beneficial haematological effect disappeared by 6 months. This simple, free and safe delivery procedure might offer a strategy to reduce early infant anaemia risk, when other interventions are not yet feasible.
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Affiliation(s)
- Patrick van Rheenen
- Department of Paediatrics, Paediatric Gastroenterology, University Medical Centre, Groningen, The Netherlands.
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Lozoff B, Lu Angelilli M, Zatakia J, Jacobson SW, Calatroni A, Beard J. Iron status of inner-city African-American infants. Am J Hematol 2007; 82:112-21. [PMID: 17019689 PMCID: PMC1906699 DOI: 10.1002/ajh.20782] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The iron status of African-American infants continues to be subject to debate. We characterized the iron status of 198 9-month-old inner-city infants (94% fed iron-fortified formula) using a comprehensive panel of measures and assessing lead and inflammation markers. The proportion with iron deficiency was calculated based on three approaches (> or = 2 abnormal iron measures with or without anemia for MCV model--NHANES II, ferritin model--NHANES III, or Sweden/Honduras study) and a promising new measure-body iron, calculated from ferritin and transferrin receptor (TfR). There were no sex differences for any iron measure. Hb < 110 g/l was observed in 25%; Hb < or = 105 g/l in 10.1%. Free erythrocyte protoporphyrin (FEP) values were elevated without elevated lead concentrations or an inflammatory response: mean FEP = 86.6 microg/dl red blood cells [75.5 micromol/mol heme]; 52.3% were > 80 microg/dl (1.42 micromol/l), almost half of which were accompanied by a second abnormal iron measure. The estimated prevalence of iron deficiency was 14.4, 5.3, and 2.5% for the MCV model, ferritin model, and Sweden/Honduras cutoffs, respectively, and 4.1% for body iron < 0 mg/kg. Regulation of iron storage is immature at < 1 year of age, making estimates of iron deficiency that depend on ferritin, including body iron, suspect in this age period. Thus, the "true" prevalence of iron deficiency could not be established with confidence due to major differences in the results, depending on the guidelines used. Functional indicators of poor iron status in young infants are urgently needed.
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Affiliation(s)
- Betsy Lozoff
- Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan 48109, USA.
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Kling PJ. The zinc protoporphyrin/heme ratio in premature infants: has it found its place? J Pediatr 2006; 148:8-10. [PMID: 16423590 PMCID: PMC1532929 DOI: 10.1016/j.jpeds.2005.09.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2005] [Accepted: 09/26/2005] [Indexed: 10/25/2022]
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Soldin SJ, Soldin OP, Boyajian AJ, Taskier MS. Pediatric brain natriuretic peptide and N-terminal pro-brain natriuretic peptide reference intervals. Clin Chim Acta 2005; 366:304-8. [PMID: 16360137 PMCID: PMC3636975 DOI: 10.1016/j.cca.2005.11.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2005] [Revised: 10/30/2005] [Accepted: 11/08/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) have been shown to be useful biomarkers for the diagnosis of heart failure. Pediatric reference intervals for these analytes have been reported in part. Previous studies lack large numbers in each group, have not covered all age ranges and have not compared results for BNP with NT-proBNP in simultaneously drawn samples. METHODS We measured BNP in whole blood using the Biosite Triage point-of-care method and plasma NT-proBNP using the Dade RxL Dimension. We assessed between and within-day precision of both methods and after removing outliers employed the Hoffmann approach to calculate pediatric reference intervals over the age range of 0-21 y. We also compared the 2 methods on simultaneously drawn samples. RESULTS Reference intervals revealed approximately 20-fold higher 97.5th percentiles for neonates than for children >3 y of age. 97.5th percentiles decreased significantly over the first 3 years of life. As shown by others, the CVs for the automated Dade RxL platform were somewhat lower than those for the POCT method. BNP and NT-proBNP correlated well in simultaneously drawn samples (r=0.947). DISCUSSION Reference intervals for BNP and NT-proBNP are far higher in neonates and infants than in children older than three years of age. The reasons for this are unknown but resemble the elevated CK-MBs and troponins also found in neonates, although the 97.5th percentiles for these latter 2 cardiac markers decrease more rapidly to values found in older children by 6 months of age.
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Affiliation(s)
- Steven J Soldin
- Departments of Medicine and Pharmacology, Georgetown University Medical Center, Washington DC 20007, USA.
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Zimmermann MB, Molinari L, Staubli-Asobayire F, Hess SY, Chaouki N, Adou P, Hurrell RF. Serum transferrin receptor and zinc protoporphyrin as indicators of iron status in African children. Am J Clin Nutr 2005; 81:615-23. [PMID: 15755831 DOI: 10.1093/ajcn/81.3.615] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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. DESIGN 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.
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Affiliation(s)
- Michael B Zimmermann
- Human Nutrition Laboratory, Swiss Federal Institute of Technology, Zürich, Switzerland.
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Soldin OP, Pezzullo JC, Hanak B, Miller M, Soldin SJ. Changing trends in the epidemiology of pediatric lead exposure: interrelationship of blood lead and ZPP concentrations and a comparison to the US population. Ther Drug Monit 2003; 25:415-20. [PMID: 12883223 PMCID: PMC3635530 DOI: 10.1097/00007691-200308000-00001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine blood lead and zinc protoporphyrin (ZPP) concentrations in a pediatric population, confirm their interrelationship at low blood lead concentrations, and assess changing trends through comparison of these data with those found in a similar population 10 years earlier and to US national values. STUDY DESIGN AND METHODS The study was conducted in a large pediatric hospital in the Washington DC area (CNMC) on patient whole blood specimens (n = 4908) (0-17 years) accrued from January 2001 to June 2002. Pediatric blood lead concentrations were determined by atomic absorption spectrophotometry, and ZPP by hematofluorometry. The data were analyzed using a computer adaptation of the Hoffmann approach. RESULTS AND CONCLUSIONS Blood lead level (BLL) means ranged between 2.2 and 3.3 micro g/dL, and the median BLL was 3 micro g/dL throughout. Mean ZPP concentrations ranged between 21.1 and 26.6 micro g/dL and the median concentrations between 21 and 27 micro g/dL. In comparison to data obtained from a similar pediatric population at CNMC between 1991 and 1992, pediatric BLLs have significantly declined in the Washington DC area. The current data are also compared with data obtained from the National Health and Nutrition Examination Survey (NHANES III) of the US population. The interrelationship between ZPP and BLLs is examined.
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