Inflammation and Micronutrient Status in Anemia Assessment
Summary
Anemia remains a pervasive global health challenge, driven not only by inadequate intake of essential micronutrients but also by the complex interplay between inflammatory processes and biomarker interpretation. Inflammatory responses, whether acute or chronic, alter the circulation and distribution of iron and other nutrients, leading to potential misclassification of deficiency or sufficiency. Key acute-phase proteins such as C-reactive protein (CRP) and α-1-acid glycoprotein (AGP) rise in response to infection or immune activation, sequestering iron in storage sites and elevating ferritin independently of nutritional status. This confounding effect complicates the assessment of iron deficiency and the estimation of its contribution to anaemia. Modern approaches increasingly employ adjustment algorithms, most notably regression correction, to account for inflammation when interpreting serum ferritin, soluble transferrin receptor (sTfR) and other biomarkers. A nuanced understanding of these interactions is critical for public health programmes, as misinterpretation can lead to inappropriate intervention strategies—either under-treating iron deficiency or over-supplementing populations in which anaemia is driven by non-nutritional causes. Integrating inflammation-adjusted biomarkers with population-representative surveys enables more accurate estimates of deficiency prevalence, informs targeted micronutrient supplementation, and ultimately strengthens global efforts to reduce the burden of anaemia in vulnerable groups.
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Inflammation and Micronutrient Status in Anemia Assessment publication trend
The graph below shows the total number of articles in inflammation and micronutrient status in anemia assessment across all publications each year (not limited to Nature Index journals).
Technical terms
Ferritin: An intracellular iron-storage protein whose serum concentration reflects total body iron stores but is elevated by inflammation.
C-reactive protein (CRP): An acute-phase protein produced by the liver that rises rapidly in response to inflammation, infection or tissue injury.
α-1-acid glycoprotein (AGP): A glycoprotein that increases during chronic or sustained inflammation, used alongside CRP to adjust micronutrient biomarkers.
Soluble transferrin receptor (sTfR): A circulating form of the transferrin receptor whose concentration indicates cellular iron demand and is less influenced by acute inflammation.
Regression correction: A statistical method that models the relationship between inflammatory markers and micronutrient biomarkers to adjust values for the influence of inflammation.
References
- Comparison of Published Estimates of the National Prevalence of Iron, Vitamin A, and Zinc Deficiency and Sources of Inconsistencies. Advances in Nutrition (2023).
- Effect of lipid-based nutrient supplements on micronutrient status and hemoglobin among children with stunting: secondary analysis of a randomized controlled trial in Uganda. American Journal of Clinical Nutrition (2024).
- Prevalence of micronutrient deficiencies across diverse environments in rural Madagascar. Frontiers in Nutrition (2024).
- Adjusting ferritin concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. American Journal of Clinical Nutrition (2017).
- Methodologic approach for the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. American Journal of Clinical Nutrition (2017).
- Adjusting soluble transferrin receptor concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. American Journal of Clinical Nutrition (2017).
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