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Inflammation Adjustment by Two Methods Decreases the Estimated Prevalence of Zinc Deficiency in Malawi

Likoswe, Blessings H; Phiri, Felix P; Broadley, Martin R.; Joy, Edward J M; Patson, Noel; Maleta, Kenneth M; Phuka, John C

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Authors

Blessings H Likoswe

Felix P Phiri

Edward J M Joy

Noel Patson

Kenneth M Maleta

John C Phuka



Abstract

Serum zinc concentration (SZC) is used widely to assess population-level zinc status. Its concentration decreases during inflammatory responses, which can affect the interpretation of the results. This study aimed to re-estimate the prevalence of zinc deficiency in Malawi based on the 2015-2016 Malawi Micronutrient Survey (MNS) data, by adjusting SZC measures with markers of inflammation. SZC and inflammation data from 2760 participants were analysed. Adjustments were made using: (1) The Internal Correction Factor (ICF) method which used geometric means, and (2) The Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) method, which used linear regression. Mean SZC values increased significantly when adjustments were made by either ICF or BRINDA (p < 0.001). The national prevalence of zinc deficiency decreased from 62% to 59%, after ICF adjustment, and to 52% after BRINDA adjustment. ICF and BRINDA values of SZC were highly correlated (p < 0.001, r = 0.99), but a Bland-Altman plot showed a lack of agreement between the two methods (bias of 2.07 µg/dL). There was no association between the adjusted SZC and stunting, which is a proxy indicator for zinc deficiency. Inflammation adjustment of SZC, using ICF or BRINDA, produces lower estimates of zinc deficiency prevalence, but the lack of agreement between the adjustment methods warrants further research. Furthermore, the lack of association between SZC and stunting highlights the need to explore other biomarkers and proxies of population zinc assessment. This study demonstrates the importance of considering inflammatory confounders when reporting SZC, to ensure accuracy and to support policy decision making.

Citation

Likoswe, B. H., Phiri, F. P., Broadley, M. R., Joy, E. J. M., Patson, N., Maleta, K. M., & Phuka, J. C. (2020). Inflammation Adjustment by Two Methods Decreases the Estimated Prevalence of Zinc Deficiency in Malawi. Nutrients, 12(6), -. https://doi.org/10.3390/nu12061563

Journal Article Type Article
Acceptance Date May 21, 2020
Online Publication Date May 27, 2020
Publication Date May 27, 2020
Deposit Date May 28, 2020
Publicly Available Date Mar 28, 2024
Journal Nutrients
Electronic ISSN 2072-6643
Publisher MDPI
Peer Reviewed Peer Reviewed
Volume 12
Issue 6
Article Number 1563
Pages -
DOI https://doi.org/10.3390/nu12061563
Keywords zinc; biomarkers; inflammation; C-reactive protein (CRP); alpha 1-acid glycoprotein (AGP); children; women of reproductive age
Public URL https://nottingham-repository.worktribe.com/output/4523995
Publisher URL https://www.mdpi.com/2072-6643/12/6/1563
Additional Information Likoswe, B.H.; Phiri, F.P.; Broadley, M.R.; Joy, E.J.M.; Patson, N.; Maleta, K.M.; Phuka, J.C. Inflammation Adjustment by Two Methods Decreases the Estimated Prevalence of Zinc Deficiency in Malawi. Nutrients 2020, 12, 1563.

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