Original Article

European Journal of Clinical Nutrition (2009) 63, 787–793; doi:10.1038/ejcn.2008.33; published online 28 May 2008

Influence of inflammation as measured by alpha-1-acid glycoprotein on iron status indicators among HIV-positive postpartum Zimbabwean women

R Rawat1, R J Stoltzfus2, R Ntozini3, K Mutasa3, P J Iliff3,4 and J H Humphrey3,4,5

  1. 1International Food Policy Research Institute, Food Consumption and Nutrition Division, Washington DC, USA
  2. 2Cornell University, Division of Nutritional Sciences, Ithaca, NY, USA
  3. 3ZVITAMBO Study Team, Harare, Zimbabwe
  4. 4The University of Zimbabwe Faculties of Medicine and Science, Harare, Zimbabwe
  5. 5Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

Correspondence: Dr R Rawat, Food Consumption and Nutrition Division, International Food Policy Research Institute, 2033 K Street, Washington DC 20006, USA. E-mail: r.rawat@cgiar.org

Received 19 July 2007; Revised 10 March 2008; Accepted 29 March 2008; Published online 28 May 2008.

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Abstract

Objectives:

 

The acute phase response (APR) influences indicators of iron status. A recent WHO/CDC consultation recommended concurrent measurement of alpha-1-acid-glycoprotein (AGP) in surveys to control for the APR, and aid in interpreting iron status. They proposed further exploratory analyses using AGP. We examined whether the APR (measured by AGP) influences the expected relationships between iron status indicators in an HIV-infected population.

Subjects:

 

We measured hemoglobin (Hb), serum ferritin (SF), transferrin receptor (TfR), erythropoietin (EPO) and AGP in a cross-sectional survey of 643 HIV-positive Zimbabwean women.

Results:

 

SF was significantly higher in APR-positive (AGP>1 g/l) women (P<0.001), in whom there was no association between SF and Hb. TfR was inversely associated with Hb, in both APR-positive and APR-negative women (P<0.001). However, among anemic women (Hb<110 g/l), APR-positive women had marginally lower TfR concentrations (P=0.053). There was no difference in EPO response to decreasing Hb among APR-positive and APR-negative women.

Conclusions:

 

AGP captured the influence of the APR on iron indicators and their relationships with each other. The APR influenced SF and its relationship with Hb as expected. TfR behaved unexpectedly. Although TfR has been promoted as an iron indicator that is uninfluenced by the APR, TfR concentrations were depressed among anemic APR-positive women. Because TfR reflects iron deficiency and erythropoietic activity, pro-inflammatory cytokines associated with the APR may be inhibiting erythropoeisis, which is reflected by lower TfR concentrations. We support the WHO/CDC recommendation that AGP is a useful indicator to assess the influence of the APR on iron status indicators.

Keywords:

acute phase response, AGP, iron status, SF, TfR, HIV

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