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Vásquez-Velásquez C, Fernandez-Guzman D, Quispe-Vicuña C, Caira-Chuquineyra B, Ccami-Bernal F, Castillo-Gutierrez P, Arredondo-Nontol M, Gonzales GF. Evaluating the Diagnostic Performance of Hemoglobin in the Diagnosis of Iron Deficiency Anemia in High-Altitude Populations: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6117. [PMID: 37372704 DOI: 10.3390/ijerph20126117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/07/2023] [Accepted: 02/26/2023] [Indexed: 06/29/2023]
Abstract
We evaluated the available literature on the diagnostic performance of hemoglobin (Hb) in the diagnosis of iron deficiency anemia (IDA) in high-altitude populations. We searched PubMed, Web of Science, Scopus, Embase, Medline by Ovid, the Cochrane Library, and LILCAS until 3 May 2022. We included studies that evaluated the diagnostic performance (sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), receiver operating characteristic (ROC) curves, and accuracy) of Hb (with and without an altitude correction factor) compared to any iron deficiency (ID) marker (e.g., ferritin, soluble transferrin receptor (sTFR), transferrin saturation, or total body iron (TBI)) in populations residing at altitudes (≥1000 m above sea level). We identified a total of 14 studies (with 4522 participants). We found disagreement in diagnostic performance test values between the studies, both in those comparing hemoglobin with and in those comparing hemoglobin without a correction factor for altitude. Sensitivity ranged from 7% to 100%, whereas specificity ranged from 30% to 100%. Three studies reported higher accuracy of uncorrected versus altitude-corrected hemoglobin. Similarly, two studies found that not correcting hemoglobin for altitude improved the receiver operating characteristic (ROC) curves for the diagnosis of iron deficiency anemia. Available studies on high-altitude populations suggest that the diagnostic accuracy of Hb is higher when altitude correction is not used. In addition, the high prevalence of anemia in altitude regions could be due to diagnostic misclassification.
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Affiliation(s)
- Cinthya Vásquez-Velásquez
- Laboratorio de Endocrinología y Reproducción, Laboratorios de Investigación y Desarrollo (LID), Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía Alberto Cazorla Tálleri, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
- Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
| | | | - Carlos Quispe-Vicuña
- Sociedad Científica San Fernando, Universidad Nacional Mayor de San Marcos, Lima 15081, Peru
| | | | - Fabricio Ccami-Bernal
- Facultad de Medicina, Universidad Nacional de San Agustín de Arequipa, Arequipa 04001, Peru
| | | | | | - Gustavo F Gonzales
- Laboratorio de Endocrinología y Reproducción, Laboratorios de Investigación y Desarrollo (LID), Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía Alberto Cazorla Tálleri, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
- Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
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Soepnel LM, Mabetha K, Draper CE, Silubonde TM, Smuts CM, Pettifor JM, Norris SA. A Cross-Sectional Study of the Associations between Biomarkers of Vitamin D, Iron Status, and Hemoglobin in South African Women of Reproductive Age: the Healthy Life Trajectories Initiative, South Africa. Curr Dev Nutr 2023; 7:100072. [PMID: 37180853 PMCID: PMC10134444 DOI: 10.1016/j.cdnut.2023.100072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/27/2023] [Accepted: 03/24/2023] [Indexed: 04/03/2023] Open
Abstract
Background Vitamin D deficiency and anemia impact the health of women of reproductive age. Evidence suggests an inverse relationship between serum vitamin D (25-hydroxyvitamin D [25(OH)D]) and anemia/iron deficiency, but less is known about these associations in women of reproductive age, in particular in a setting with a combined burden of micronutrient deficiency, food insecurity, and obesity. Objective We aimed to assess the associations between 25(OH)D and biomarkers of iron and anemia in a cohort of women of reproductive age from Soweto, South Africa. The prevalence of vitamin D deficiency was also assessed. Methods In this cross-sectional substudy of the Healthy Life Trajectories Initiative (HeLTI) South Africa pilot trial, 25(OH)D, iron markers (ferritin and soluble transferrin receptor [sTFR]), and altitude-adjusted hemoglobin (Hb) were measured in 493 women aged 18 to 25 years. Associations between iron deficiency/anemia and vitamin D status were evaluated using multivariable logistic regression, adjusting for confounders including fat mass index (FMI). Structural equation modeling (SEM) was performed to evaluate direct and indirect pathways between 25(OH)D, iron and anemia markers, and covariates. Results Of 493 participants, 136 (27.6%) had vitamin D insufficiency (25(OH)D ≥12-20 ng/mL), whereas 28 (5.6%) had vitamin D deficiency (<12 ng/mL). Anemia and iron deficiency were not significantly associated with vitamin D category (25(OH)D<20 ng/mL compared with ≥20 ng/mL) in multivariable logistic regression analyses. In SEM, log-transformed 25(OH)D was not significantly associated with Hb, ferritin, or sTFR, but it was significantly associated with season of data collection, hormonal contraceptive use, and FMI (total effects: B = 0.17, 95% CI: 0.104, 0.236, P < 0.001; B: 0.10, 95% CI: 0.041, 0.154, P < 0.001; B: -0.01, 95%CI: -0.016, -0.003, P = 0.003, respectively). Conclusion No significant association between vitamin D (25(OH)D), anemia (Hb), and iron markers was found. The inverse relationship between FMI and vitamin D status emphasizes the overlap between adiposity and micronutrient deficiencies in young South African women, exacerbating their risk of disease development.
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Affiliation(s)
- Larske M. Soepnel
- SA MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Khuthala Mabetha
- SA MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Catherine E. Draper
- SA MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Takana Mary Silubonde
- SA MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Cornelius M. Smuts
- Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - John M. Pettifor
- SA MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A. Norris
- SA MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Global Health Research Institute, School of Human Development and Health, University of Southampton, Southampton, United Kingdom
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Soepnel LM, McKinley MC, Klingberg S, Draper CE, Prioreschi A, Norris SA, Ware LJ. Evaluation of a Text Messaging Intervention to Promote Preconception Micronutrient Supplement Use: Feasibility Study Nested in the Healthy Life Trajectories Initiative Study in South Africa. JMIR Form Res 2022; 6:e37309. [PMID: 35980731 PMCID: PMC9437786 DOI: 10.2196/37309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/25/2022] [Accepted: 05/09/2022] [Indexed: 11/28/2022] Open
Abstract
Background Social messaging strategies such as SMS text messaging and radio are promising avenues for health promotion and behavior change in low- to middle-income settings. However, evidence of their acceptability, feasibility, and impact in the context of young women’s health and micronutrient deficiencies is lacking. Objective This study aimed to evaluate the feasibility of an automated 2-way text messaging intervention nested in an ongoing preconception health trial, the Healthy Life Trajectories Initiative (HeLTI; HeLTI Bukhali) in Soweto, South Africa. Second, we aimed to evaluate the acceptability of a health promotion radio serial, which aired concurrently in the region. Methods In this feasibility study, 120 participants enrolled in HeLTI Bukhali between November 2020 and February 2021 received the 6-month 2-way text messaging intervention. Quantitative and qualitative data on intervention acceptability, usability, interaction, perceived benefit, and fidelity were collected during 5 focus group discussions (FGDs) and from study data logs. During the FGDs, data were collected on the acceptability of the radio serial. Following the text messaging intervention, capillary hemoglobin levels were assessed, and a participant questionnaire provided information on adherence and attitudes toward supplements. The text messaging control group comprised the first 120 women recruited from November 2019 to February 2020, who received the Bukhali intervention but not the text messages. Statistical significance testing and a linear mixed model were used for indicative effect comparisons between the text message–receiving and control groups. Results The text messaging intervention was found to be acceptable and to have perceived benefits, including being reminded to take supplements, gaining knowledge, and feeling supported by the study team. The use of the 2-way text messaging reply function was limited, with only a 10.8% (13/120) response rate by week 24. Barriers to replying included a lack of interest or phone credit and technical issues. Regarding the indicative effect, participants receiving the text messages had higher self-reported adherence at follow-up than the text messaging control group (42/63, 67% vs 33/85, 39% taking supplements every time; P=.02), and altitude-adjusted hemoglobin increased more between baseline and follow-up in the SMS text message–receiving group than in the text messaging control group (1.03, 95% CI 0.49-1.57; P<.001). The radio serial content was acceptable, although few participants reported exposure before the FGD. Conclusions Women reported that the text messaging intervention was useful and described the benefits of receiving the messages. Examination of hemoglobin status indicated a promising beneficial effect of text messaging support on adherence to micronutrient supplementation, requiring further exploration through randomized controlled studies. Health promotion through radio and text messages were both found to be acceptable, although more research into the radio serial reach among young women is needed. Trial Registration Pan African Clinical Trials Registry (PACTR) PACTR201903750173871; https://tinyurl.com/4x6n32ff
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Affiliation(s)
- Larske M Soepnel
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Michelle C McKinley
- Centre for Public Health, School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Sonja Klingberg
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Catherine E Draper
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alessandra Prioreschi
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
- School of Health and Human Development, University of Southampton, Southampton, United Kingdom
| | - Lisa J Ware
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
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Norris SA, Draper CE, Prioreschi A, Smuts CM, Ware LJ, Dennis C, Awadalla P, Bassani D, Bhutta Z, Briollais L, Cameron DW, Chirwa T, Fallon B, Gray CM, Hamilton J, Jamison J, Jaspan H, Jenkins J, Kahn K, Kengne AP, Lambert EV, Levitt N, Martin MC, Ramsay M, Roth D, Scherer S, Sellen D, Slemming W, Sloboda D, Szyf M, Tollman S, Tomlinson M, Tough S, Matthews SG, Richter L, Lye S. Building knowledge, optimising physical and mental health and setting up healthier life trajectories in South African women ( Bukhali): a preconception randomised control trial part of the Healthy Life Trajectories Initiative (HeLTI). BMJ Open 2022; 12:e059914. [PMID: 35450913 PMCID: PMC9024255 DOI: 10.1136/bmjopen-2021-059914] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION South Africa's evolving burden of disease is challenging due to a persistent infectious disease, burgeoning obesity, most notably among women and rising rates of non-communicable diseases (NCDs). With two thirds of women presenting at their first antenatal visit either overweight or obese in urban South Africa (SA), the preconception period is an opportunity to optimise health and offset transgenerational risk of both obesity and NCDs. METHODS AND ANALYSIS Bukhali is the first individual randomised controlled trial in Africa to test the efficacy of a complex continuum of care intervention and forms part of the Healthy Life Trajectories Initiative (HeLTI) consortium implementing harmonised trials in Canada, China, India and SA. Starting preconception and continuing through pregnancy, infancy and childhood, the intervention is designed to improve nutrition, physical and mental health and health behaviours of South African women to offset obesity-risk (adiposity) in their offspring. Women aged 18-28 years (n=6800) will be recruited from Soweto, an urban-poor area of Johannesburg. The primary outcome is dual-energy X-ray absorptiometry derived fat mass index (fat mass divided by height2) in the offspring at age 5 years. Community health workers will deliver the intervention randomly to half the cohort by providing health literacy material, dispensing a multimicronutrient supplement, providing health services and feedback, and facilitating behaviour change support sessions to optimise: (1) nutrition, (2) physical and mental health and (3) lay the foundations for healthier pregnancies and early child development. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Human Ethics Research Committee University of the Witwatersrand, Johannesburg, South Africa (M1811111), the University of Toronto, Canada (19-0066-E) and the WHO Ethics Committee (ERC.0003328). Data and biological sample sharing policies are consistent with the governance policy of the HeLTI Consortium (https://helti.org) and South African government legislation (POPIA). The recruitment and research team will obtain informed consent. TRIAL REGISTRATION This trial is registered with the Pan African Clinical Trials Registry (https://pactr.samrc.ac.za) on 25 March 2019 (identifier: PACTR201903750173871). PROTOCOL VERSION 20 March 2022 (version #4). Any protocol amendments will be communicated to investigators, Institutional Review Board (IRB)s, trial participants and trial registries.
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Affiliation(s)
- Shane A Norris
- SAMRC Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
- Global Health Research Institute, School of Human Development and Health, University of Southampton, Southampton, UK
| | - Catherine E Draper
- SAMRC Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Alessandra Prioreschi
- SAMRC Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - C M Smuts
- Centre of Excellence of Nutrition, North-West University, Potchefstroom, South Africa
| | - Lisa Jayne Ware
- SAMRC Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - CindyLee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronton, Ontario, Canada
| | - Philip Awadalla
- Department of Molecular Genetics, Ontario Institute for Cancer Research, University of Toronto, Toronto, Ontario, Canada
| | - D Bassani
- Centre for Global Child Health, SickKids Research Institute, Toronto, Ontario, Canada
| | - Zulfiqar Bhutta
- Centre for Global Child Health, SickKids Research Institute, Toronto, Ontario, Canada
- Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan
| | | | - D William Cameron
- Medicine, Division of Infectious Diseases, Ottawa Hospital General Campus, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Tobias Chirwa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - B Fallon
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - C M Gray
- Division of Molecular Biology and Human Genetics, University of Stellenbosch, Stellenbosch, South Africa
- Division of Immunology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Rondebosch, South Africa
| | - Jill Hamilton
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - J Jamison
- Community Services, Red River College, Winnipeg, Manitoba, Canada
| | - Heather Jaspan
- Division of Immunology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Rondebosch, South Africa
| | - Jennifer Jenkins
- Department of Applied Psychology and Human Development, University of Toronto, Toronto, Ontario, Canada
| | - Kathleen Kahn
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- SAMRC Rural Public Health and Health Transitions Research Unit (Agincourt), Uinversity of the Witwatersrand, Johannesburg, South Africa
| | - A P Kengne
- Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Estelle V Lambert
- Division of Exercise Science and Sports Medicine, University of Cape Town, Rondebosch, South Africa
| | - Naomi Levitt
- Chronic Diseases Initiative for Africa, University of Cape Town, Cape Town, South Africa
| | | | - Michele Ramsay
- Sydney Brenner Institute for Molecular Bioscience, University of the Witwatersrand, Johannesburg, South Africa
| | - Daniel Roth
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stephen Scherer
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Sellen
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Wiedaad Slemming
- Department of Paediatrics, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Deborah Sloboda
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - M Szyf
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
| | - Stephen Tollman
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- SAMRC Rural Public Health and Health Transitions Research Unit (Agincourt), Uinversity of the Witwatersrand, Johannesburg, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, University of Stellenbosch, Cape Town, South Africa
| | - Suzanne Tough
- Department of Paediatrics, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Stephen G Matthews
- Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
- Department of Physiology, Obstetrics & Gynaecology and Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Linda Richter
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Lye
- SAMRC Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
- Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
- Department of Physiology, Obstetrics & Gynaecology and Medicine, University of Toronto, Toronto, Ontario, Canada
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Prioreschi A, Koethe JR, Aronoff DM, Goldstein JA, Norris SA. Relationships between adiposity distribution and metabolic health in preconception women in South Africa. Obes Sci Pract 2022; 8:500-509. [PMID: 35949276 PMCID: PMC9358758 DOI: 10.1002/osp4.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 11/24/2022] Open
Abstract
Objective Adipose tissue is a central regulator of metabolic health and a contributor to systemic inflammation. Patterns of adiposity deposition are important to understand for optimizing health. This study aimed to asses relationships between adiposity deposition and metabolic and inflammatory biomarkers in South African women prior to conception. Methods Non‐pregnant, healthy women (n = 298) were recruited for this cross‐sectional study via home visits. Body composition was measured by Dual X‐ray Absorptiometry. Inflammation markers C‐reactive protein (CRP), alpha1‐acid glycoprotein (AGP), hemoglobin A1c (HbA1c), and blood pressure were scored according to risk. A summative metabolic health risk score was created for women with obesity. Generalized regression models assessed relationships between adiposity deposition and outcomes with adjustment for potential confounders. Results Obesity was present in 22% of women (mean age = 20.93 years). Fat mass index was associated with inflammation and metabolic health risk (β = 0.58; p < 0.01). Visceral fat, trunk:limb ratio, android:gynoid ratio, body mass index, weight, and waist circumference were positively associated with CRP, AGP, and metabolic health risk (p < 0.01). Weight was associated with Hba1c (β < 0.01; p < 0.05). Participants with obesity and low metabolic health risk had lower fat mass index and visceral fat than participants with obesity and higher metabolic health risk. Conclusions Black South African women accumulated excess adipose tissue in abdominal regions. While fat mass and body mass were associated with inflammation and metabolic health risk, women with obesity and with lower fat mass index and lower visceral adipose tissue were metabolically protected. Identification of women at risk for metabolic disease preconception could help ensure future healthy pregnancies and prevent transference of risk to offspring.
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Affiliation(s)
- Alessandra Prioreschi
- SAMRC/Wits Developmental Pathways for Health Research Unit Department of Paediatrics Faculty of Health Sciences School of Clinical Medicine University of the Witwatersrand Johannesburg South Africa
| | - John R. Koethe
- Division of Infectious Diseases Department of Medicine Vanderbilt University Medical Center Nashville Tennessee USA
- Vanderbilt Institute for Global Health Vanderbilt University Medical Center Nashville Tennessee USA
| | - David M. Aronoff
- SAMRC/Wits Developmental Pathways for Health Research Unit Department of Paediatrics Faculty of Health Sciences School of Clinical Medicine University of the Witwatersrand Johannesburg South Africa
- Division of Infectious Diseases Department of Medicine Vanderbilt University Medical Center Nashville Tennessee USA
- Department of Pathology, Microbiology and Immunology Vanderbilt University Medical Center Nashville Tennessee USA
- Department of Obstetrics and Gynecology Vanderbilt University Medical Center Nashville Tennessee USA
| | - Jeffrey A. Goldstein
- Department of Pathology Feinberg School of Medicine Northwestern University Chicago Illinois USA
| | - Shane A. Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit Department of Paediatrics Faculty of Health Sciences School of Clinical Medicine University of the Witwatersrand Johannesburg South Africa
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Silubonde TM, Draper CE, Baumgartner J, Ware LJ, Smuts CM, Norris SA. Barriers and facilitators of micronutrient supplementation among non-pregnant women of reproductive age in Johannesburg, South Africa. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001310. [PMID: 36962846 PMCID: PMC10021408 DOI: 10.1371/journal.pgph.0001310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/30/2022] [Indexed: 12/02/2022]
Abstract
The prevalence of anaemia among South African women of reproductive age (WRA) remains high at 39%. Multiple micronutrient supplementation (MMS) may be an effective strategy in the prevention and management of anaemia. Our aim was to understand facilitators and barriers to preconception MMS adherence and to explore perceptions and beliefs of MMS in the prevention and treatment of anaemia among non-pregnant WRA. This qualitative study was embedded in a preconception MMS intervention trial of WRA and was conducted in two phases. Phase one assessed the barriers and facilitators of MMS adherence. Individual interviews were conducted with the community health workers (n = 7) administering MMS, and with non-pregnant WRA (n = 25) participating in the trial. Phase two included four focus groups with participating WRA (n = 26), which further explored participants' perceptions and beliefs of MMS provision and adherence, and strategies to improve adherence. The reported facilitators to supplementation were family support, interaction with the community health workers, easy access to MMS, and experienced benefits of MMS. Barriers to preconception supplementation included the lack of family support, the link of supplements to antenatal care, and the perceived lack of benefits of MMS. Participants reported negative associations of supplements with medication, individual and societal stigma around medication and challenges around the supplementation schedule. For successful preconception MMS interventions, young women, their families, and communities need to be convinced of the value of supplementation. Public health interventions utilising preconception supplementation will require specialised training for health care providers, targeted counselling materials and community household support.
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Affiliation(s)
- Takana M Silubonde
- Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Catherine E Draper
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeannine Baumgartner
- Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
- Department of Nutritional Sciences, King's College London, London, United Kingdom
| | - Lisa J Ware
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cornelius M Smuts
- Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Shane A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Health and Human Development, University of Southampton, Southampton, United Kingdom
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7
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Brindle E, Lillis L, Barney R, Bansil P, Hess SY, Wessells KR, Ouédraogo CT, Arredondo F, Barker MK, Craft NE, Fischer C, Graham JL, Havel PJ, Karakochuk CD, Zhang M, Mussai EX, Mapango C, Randolph JM, Wander K, Pfeiffer CM, Murphy E, Boyle DS. A multicenter analytical performance evaluation of a multiplexed immunoarray for the simultaneous measurement of biomarkers of micronutrient deficiency, inflammation and malarial antigenemia. PLoS One 2021; 16:e0259509. [PMID: 34735520 PMCID: PMC8568126 DOI: 10.1371/journal.pone.0259509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 10/20/2021] [Indexed: 11/19/2022] Open
Abstract
A lack of comparative data across laboratories is often a barrier to the uptake and adoption of new technologies. Furthermore, data generated by different immunoassay methods may be incomparable due to a lack of harmonization. In this multicenter study, we describe validation experiments conducted in a single lab and cross-lab comparisons of assay results to assess the performance characteristics of the Q-plex™ 7-plex Human Micronutrient Array (7-plex), an immunoassay that simultaneously quantifies seven biomarkers associated with micronutrient (MN) deficiencies, inflammation and malarial antigenemia using plasma or serum; alpha-1-acid glycoprotein, C-reactive protein, ferritin, histidine-rich protein 2, retinol binding protein 4, soluble transferrin receptor, and thyroglobulin. Validations included repeated testing (n = 20 separately prepared experiments on 10 assay plates) in a single lab to assess precision and linearity. Seven independent laboratories tested 76 identical heparin plasma samples collected from a cohort of pregnant women in Niger using the same 7-plex assay to assess differences in results across laboratories. In the analytical validation experiments, intra- and inter-assay coefficients of variation were acceptable at <6% and <15% respectively and assay linearity was 96% to 99% with the exception of ferritin, which had marginal performance in some tests. Cross-laboratory comparisons showed generally good agreement between laboratories in all analyte results for the panel of 76 plasma specimens, with Lin's concordance correlation coefficient values averaging ≥0.8 for all analytes. Excluding plates that would fail routine quality control (QC) standards, the inter-assay variation was acceptable for all analytes except sTfR, which had an average inter-assay coefficient of variation of ≥20%. This initial cross-laboratory study demonstrates that the 7-plex test protocol can be implemented by users with some experience in immunoassay methods, but familiarity with the multiplexed protocol was not essential.
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Affiliation(s)
- Eleanor Brindle
- Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington, United States of America
| | | | | | - Pooja Bansil
- PATH, Seattle, Washington, United States of America
| | - Sonja Y. Hess
- Department of Molecular Biosciences, School of Veterinary Medicine and Department of Nutrition, University of California, Davis, California, United States of America
| | - K. Ryan Wessells
- Department of Molecular Biosciences, School of Veterinary Medicine and Department of Nutrition, University of California, Davis, California, United States of America
| | - Césaire T. Ouédraogo
- Department of Molecular Biosciences, School of Veterinary Medicine and Department of Nutrition, University of California, Davis, California, United States of America
- Helen Keller International, Niamey, Niger
| | - Francisco Arredondo
- Duke University Medical Ctr. Durham, Durham, North Carolina, United States of America
| | - Mikaela K. Barker
- Faculty of Land and Food Systems, University of British Columbia, Vancouver, British Columbia, Canada
| | - Neal E. Craft
- Craft Nutrition Consulting, Elm City, North Carolina, United States of America
| | - Christina Fischer
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - James L. Graham
- Department of Molecular Biosciences, School of Veterinary Medicine and Department of Nutrition, University of California, Davis, California, United States of America
| | - Peter J. Havel
- Department of Molecular Biosciences, School of Veterinary Medicine and Department of Nutrition, University of California, Davis, California, United States of America
| | - Crystal D. Karakochuk
- Faculty of Land and Food Systems, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mindy Zhang
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ei-Xia Mussai
- Faculty of Land and Food Systems, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carine Mapango
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jody M. Randolph
- Department of Molecular Biosciences, School of Veterinary Medicine and Department of Nutrition, University of California, Davis, California, United States of America
| | - Katherine Wander
- Binghamton University (SUNY), Binghamton, New York, United States of America
| | - Christine M. Pfeiffer
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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André M, Brucato N, Plutniak S, Kariwiga J, Muke J, Morez A, Leavesley M, Mondal M, Ricaut FX. Phenotypic differences between highlanders and lowlanders in Papua New Guinea. PLoS One 2021; 16:e0253921. [PMID: 34288918 PMCID: PMC8294550 DOI: 10.1371/journal.pone.0253921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/16/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Altitude is one of the most demanding environmental pressures for human populations. Highlanders from Asia, America and Africa have been shown to exhibit different biological adaptations, but Oceanian populations remain understudied [Woolcock et al., 1972; Cotes et al., 1974; Senn et al., 2010]. We tested the hypothesis that highlanders phenotypically differ from lowlanders in Papua New Guinea, as a result of inhabiting the highest mountains in Oceania for at least 20,000 years. MATERIALS AND METHODS We collected data for 13 different phenotypes related to altitude for 162 Papua New Guineans living at high altitude (Mont Wilhelm, 2,300-2,700 m above sea level (a.s.l.) and low altitude (Daru, <100m a.s.l.). Multilinear regressions were performed to detect differences between highlanders and lowlanders for phenotypic measurements related to body proportions, pulmonary function, and the circulatory system. RESULTS Six phenotypes were significantly different between Papua New Guinean highlanders and lowlanders. Highlanders show shorter height (p-value = 0.001), smaller waist circumference (p-value = 0.002), larger Forced Vital Capacity (FVC) (p-value = 0.008), larger maximal (p-value = 3.20e -4) and minimal chest depth (p-value = 2.37e -5) and higher haemoglobin concentration (p-value = 3.36e -4). DISCUSSION Our study reports specific phenotypes in Papua New Guinean highlanders potentially related to altitude adaptation. Similar to other human groups adapted to high altitude, the evolutionary history of Papua New Guineans appears to have also followed an adaptive biological strategy for altitude.
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Affiliation(s)
- Mathilde André
- Estonian Biocentre, Institute of Genomics, University of Tartu, Tartu, Tartumaa, Estonia
| | - Nicolas Brucato
- Laboratoire Évolution and Diversité Biologique (EDB UMR5174), Université de Toulouse Midi-Pyrénées, CNRS, IRD, UPS, Toulouse, France
| | - Sébastien Plutniak
- Laboratoire Travaux et Recherches Archéologiques sur les Cultures, les Espaces et les Sociétés (TRACES, UMR 5608), Université Toulouse Jean Jaurès, Maison de la Recherche, Toulouse, France
| | - Jason Kariwiga
- Strand of Anthropology, Sociology and Archaeology, School of Humanities & Social Sciences, University of Papua New Guinea, National Capital District, Papua New Guinea
- School of Social Science, University of Queensland, Australia, St Lucia, Australia
| | - John Muke
- Social Research Institute Ltd, Port Moresby, Papua New Guinea
| | - Adeline Morez
- School of Biological and Environmental Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Matthew Leavesley
- Strand of Anthropology, Sociology and Archaeology, School of Humanities & Social Sciences, University of Papua New Guinea, National Capital District, Papua New Guinea
- ARC Centre of Excellence for Australian Biodiversity and Heritage, College of Arts, Society and Education, James Cook University, Cairns, Australia
| | - Mayukh Mondal
- Estonian Biocentre, Institute of Genomics, University of Tartu, Tartu, Tartumaa, Estonia
| | - François-Xavier Ricaut
- Laboratoire Évolution and Diversité Biologique (EDB UMR5174), Université de Toulouse Midi-Pyrénées, CNRS, IRD, UPS, Toulouse, France
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Food insecurity, diet quality and body composition: data from the Healthy Life Trajectories Initiative (HeLTI) pilot survey in urban Soweto, South Africa. Public Health Nutr 2021; 24:1629-1637. [PMID: 33632371 DOI: 10.1017/s136898002100046x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine whether food security, diet diversity and diet quality are associated with anthropometric measurements and body composition among women of reproductive age. The association between food security and anaemia prevalence was also tested. DESIGN Secondary analysis of cross-sectional data from the Healthy Life Trajectories Initiative (HeLTI) study. Food security and dietary data were collected by an interviewer-administered questionnaire. Hb levels were measured using a HemoCue, and anaemia was classified as an altitude-adjusted haemoglobin level < 12·5 g/dl. Body size and composition were assessed using anthropometry and dual-energy x-ray absorptiometry. SETTING The urban township of Soweto, Johannesburg, South Africa. PARTICIPANTS Non-pregnant women aged 18-25 years (n 1534). RESULTS Almost half of the women were overweight or obese (44 %), and 9 % were underweight. Almost a third of women were anaemic (30 %). The prevalence rates of anaemia and food insecurity were similar across BMI categories. Food insecure women had the least diverse diets, and food security was negatively associated with diet quality (food security category v. diet quality score: B = -0·35, 95 % CI -0·70, -0·01, P = 0·049). Significant univariate associations were observed between food security and total lean mass. However, there were no associations between food security and body size or composition variables in multivariate models. CONCLUSIONS Our data indicate that food security is an important determinant of diet quality in this urban-poor, highly transitioned setting. Interventions to improve maternal and child nutrition should recognise both food security and the food environment as critical elements within their developmental phases.
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